Provider Demographics
NPI:1841413804
Name:AMON MEADOWS DMD PC
Entity Type:Organization
Organization Name:AMON MEADOWS DMD PC
Other - Org Name:AMON MEADOWS DMD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-799-8499
Mailing Address - Street 1:4686 SOUTH ATLANTA RD SUITE I
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080
Mailing Address - Country:US
Mailing Address - Phone:404-799-8499
Mailing Address - Fax:404-799-8496
Practice Address - Street 1:4686 SOUTH ATLANTA RD SUITE I
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:404-799-8499
Practice Address - Fax:404-799-8496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA117631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00772461DMedicaid