Provider Demographics
NPI:1972928158
Name:FIELDS, EDDIE RONALD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:RONALD
Last Name:FIELDS
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2301 LULLWATER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3180
Mailing Address - Country:US
Mailing Address - Phone:229-439-8896
Mailing Address - Fax:229-435-4773
Practice Address - Street 1:2301 LULLWATER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0001
Practice Address - Country:US
Practice Address - Phone:229-439-8896
Practice Address - Fax:229-435-4773
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2016-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GADN0148131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry