Paul Ivey Nettles Llc
LBN: Paul Ivey Nettles Llc
Paul Ivey Nettles Llc is an health care organization with primary practice located at 1177 Garden Walk Blvd , College Park GA 30349-6245. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / General Practice is the primary health care specialty.
Paul Ivey Nettles Llc can be contacted via phone (770) 997-9090, or through Nettles, Paul I via phone (770) 997-9090.
Contact Information
Primary practice address
1177 Garden Walk Blvd
College Park GA 30349-6245
Phone: (770) 997-9090
Fax:
Website:
Authorized official contact:
Name: Nettles, Paul I Doctor of Dental Medicine (DMD)
Phone: (770) 997-9090
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 11589 | Georgia |
| Dental Providers / Pediatric Dentistry | 1223P0221X | 6742 | Georgia |
Profile Details
| NPI number | 1063564078 |
|---|---|
| LBN Legal business name | Paul Ivey Nettles Llc |
| DBA Doing business as | |
| Authorized official | Nettles, Paul I Doctor of Dental Medicine (DMD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jan 18th, 2007 |
| Last updated | Aug 22nd, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063564078 | NPPES |
| Georgia | MEDICAID | 0050949A |
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