Provider Demographics
NPI:1922338128
Name:POPE-OZIMBA, JEANNETTE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:MARIE
Last Name:POPE-OZIMBA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W 3RD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-3647
Mailing Address - Country:US
Mailing Address - Phone:229-435-6161
Mailing Address - Fax:229-465-6191
Practice Address - Street 1:1505 W 3RD AVE
Practice Address - Street 2:STE A
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3647
Practice Address - Country:US
Practice Address - Phone:229-465-6161
Practice Address - Fax:229-435-6191
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN116101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000796617CMedicaid