Provider Demographics
NPI:1497962997
Name:JIMMY W ARNOLD, DMD
Entity Type:Organization
Organization Name:JIMMY W ARNOLD, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-757-9620
Mailing Address - Street 1:152 N CREST BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1846
Mailing Address - Country:US
Mailing Address - Phone:478-757-9620
Mailing Address - Fax:
Practice Address - Street 1:152 N CREST BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1846
Practice Address - Country:US
Practice Address - Phone:478-757-9620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JIMMY W. ARNOLD, D.M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0111891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty