Provider Demographics
NPI:1598030884
Name:JARRELL, MARY CAROLINE (DMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLINE
Last Name:JARRELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4669
Mailing Address - Country:US
Mailing Address - Phone:706-327-6262
Mailing Address - Fax:
Practice Address - Street 1:2570 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4669
Practice Address - Country:US
Practice Address - Phone:843-513-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty