Provider Demographics
NPI:1770615825
Name:MCDONALD, JAMES J JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1360 CADUCEUS WAY
Mailing Address - Street 2:BLDG 500 STE 101
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7300
Mailing Address - Country:US
Mailing Address - Phone:706-548-0604
Mailing Address - Fax:706-353-0884
Practice Address - Street 1:1360 CADUCEUS WAY
Practice Address - Street 2:BLDG 500 STE 101
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7300
Practice Address - Country:US
Practice Address - Phone:706-548-0604
Practice Address - Fax:706-353-0884
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA90151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52160463-002OtherBLUE CROSS BLUE SHIELD
GAU25491Medicare UPIN
GA19NCBFHMedicare ID - Type Unspecified