Provider Demographics
NPI:1265578769
Name:AMMONS, ADRIENNE EMBRY (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:EMBRY
Last Name:AMMONS
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 1:11349 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6261
Mailing Address - Country:US
Mailing Address - Phone:678-619-2388
Mailing Address - Fax:678-392-4420
Practice Address - Street 1:11349 TARA BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6261
Practice Address - Country:US
Practice Address - Phone:678-619-2388
Practice Address - Fax:678-392-4420
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0132381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice