Provider Demographics
NPI:1619652211
Name:MARS, GEORGIA CAROLINE MAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:CAROLINE MAY
Last Name:MARS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:MAY
Other - Last Name:MARS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4324 N HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6131
Mailing Address - Country:US
Mailing Address - Phone:601-624-4421
Mailing Address - Fax:
Practice Address - Street 1:276 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6016
Practice Address - Country:US
Practice Address - Phone:601-782-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4384-23122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist