Provider Demographics
NPI:1841344819
Name:CHOATE, BRIAN JACKSON (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JACKSON
Last Name:CHOATE
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-0400
Mailing Address - Country:US
Mailing Address - Phone:770-382-0921
Mailing Address - Fax:770-607-1821
Practice Address - Street 1:211 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3319
Practice Address - Country:US
Practice Address - Phone:770-382-0921
Practice Address - Fax:770-607-1821
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0111851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice