Provider Demographics
NPI:1770650848
Name:CAREY, JOHN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:CAREY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4508 HOLLY SPRGS PKWY
Mailing Address - Street 2:STE 1
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7842
Mailing Address - Country:US
Mailing Address - Phone:770-345-8118
Mailing Address - Fax:770-345-7219
Practice Address - Street 1:4508 HOLLY SPRGS PKWY
Practice Address - Street 2:STE 1
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7842
Practice Address - Country:US
Practice Address - Phone:770-345-8118
Practice Address - Fax:770-345-7219
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA121481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA887334BMedicaid
GA887334BMedicaid
GAU3670Medicare UPIN