Provider Demographics
NPI:1740352384
Name:HOWELL, E ALEX JR (DMD)
Entity type:Individual
Prefix:DR
First Name:E ALEX
Middle Name:
Last Name:HOWELL
Suffix:JR
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 1:338 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-2554
Mailing Address - Country:US
Mailing Address - Phone:229-723-3581
Mailing Address - Fax:229-723-6254
Practice Address - Street 1:338 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2554
Practice Address - Country:US
Practice Address - Phone:229-723-3581
Practice Address - Fax:229-723-6254
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9180267Medicaid
GA101082Medicaid