Ga Southern Dental Ppo

NPI #1346076122 in Hahira, Georgia

Provider Information

NPI Number: 1346076122
Entity Type: Organization
Organization Name: Ga Southern Dental Ppo
Subpart: Yes (part of a larger organization)
Parent Organization: GA SOUTHERN DENTAL PPO
Primary Specialty: Dentist
Enumeration Date: Sep 10, 2024
Last Updated: May 1, 2025

Practice Location

Address: 950 GA HIGHWAY 122 W
City: Hahira
State: Georgia
ZIP Code: 31632-1061
Phone: (229) 588-8858

Authorized Official

Name: ERIKA MELISSA MENJIVAR
Title: SR. CREDENTIALING SPECIALIST
Phone: (469) 596-6137

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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