Provider Demographics
NPI:1629025481
Name:DRS. TOMMY L OWENS & MARION W STAFFORD, P.C.
Entity Type:Organization
Organization Name:DRS. TOMMY L OWENS & MARION W STAFFORD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-351-9307
Mailing Address - Street 1:1938 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1267
Mailing Address - Country:US
Mailing Address - Phone:404-351-9307
Mailing Address - Fax:404-355-2555
Practice Address - Street 1:1938 PEACHTREE RD NW
Practice Address - Street 2:SUITE 307
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1267
Practice Address - Country:US
Practice Address - Phone:404-351-9307
Practice Address - Fax:404-355-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty