Provider Demographics
NPI:1467712745
Name:MOTTLEY, ALVIN WHITNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:WHITNEY
Last Name:MOTTLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6367 GOTHARDS LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-3643
Mailing Address - Country:US
Mailing Address - Phone:770-693-5316
Mailing Address - Fax:770-693-5316
Practice Address - Street 1:8505 HOSPITAL DR
Practice Address - Street 2:SUITES 7 & 8
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2414
Practice Address - Country:US
Practice Address - Phone:770-489-6735
Practice Address - Fax:770-489-6737
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO13779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist