Provider Demographics
NPI:1255354494
Name:DECKMAN, JAMES MCCLELLAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MCCLELLAN
Last Name:DECKMAN
Suffix:
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 1:125A COMMERCE DR
Mailing Address - Street 2:PO BOX 219
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2034
Mailing Address - Country:US
Mailing Address - Phone:770-487-8787
Mailing Address - Fax:770-486-1565
Practice Address - Street 1:125A COMMERCE DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2034
Practice Address - Country:US
Practice Address - Phone:770-487-8787
Practice Address - Fax:770-486-1565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice