Provider Demographics
NPI:1891905683
Name:MARABLE, ULYSSES LUTHER III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ULYSSES
Middle Name:LUTHER
Last Name:MARABLE
Suffix:III
Gender:M
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:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-1057
Mailing Address - Country:US
Mailing Address - Phone:478-825-3000
Mailing Address - Fax:478-825-3099
Practice Address - Street 1:1030 PEACH PKWY
Practice Address - Street 2:SUITE 99
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-8181
Practice Address - Country:US
Practice Address - Phone:478-825-3000
Practice Address - Fax:478-825-3099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0132231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice