Provider Demographics
NPI:1518186915
Name:JON A DRAWDY DMD PC
Entity Type:Organization
Organization Name:JON A DRAWDY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DRAWDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-285-0062
Mailing Address - Street 1:504 SCREVEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501
Mailing Address - Country:US
Mailing Address - Phone:912-285-0062
Mailing Address - Fax:912-285-5006
Practice Address - Street 1:504 SCREVEN AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3464
Practice Address - Country:US
Practice Address - Phone:912-285-0062
Practice Address - Fax:912-285-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0112821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty