Provider Demographics
NPI:1265072193
Name:GEORGIA DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:GEORGIA DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NETTIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-848-2685
Mailing Address - Street 1:500 AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4356
Mailing Address - Country:US
Mailing Address - Phone:229-246-3023
Mailing Address - Fax:
Practice Address - Street 1:500 AMELIA AVE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4356
Practice Address - Country:US
Practice Address - Phone:229-246-3023
Practice Address - Fax:229-246-0073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA DENTAL ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-08
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental