Provider Demographics
NPI:1023135738
Name:MAGUALIE J. WOOLLERY, D.M.D., P.C.
Entity type:Organization
Organization Name:MAGUALIE J. WOOLLERY, D.M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGUALIE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOOLLERY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-639-0080
Mailing Address - Street 1:7760 HAMPTON PL
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6770
Mailing Address - Country:US
Mailing Address - Phone:678-639-0080
Mailing Address - Fax:678-639-0088
Practice Address - Street 1:7760 HAMPTON PL
Practice Address - Street 2:BUILDING 6
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6770
Practice Address - Country:US
Practice Address - Phone:678-639-0080
Practice Address - Fax:678-639-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012142261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental