ORAL & FACIAL SURGERY OF EAST ALABAMA, LLC (NPI# 1225543515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225543515 |
| Entity Type | Organization |
| Organization Name | ORAL & FACIAL SURGERY OF EAST ALABAMA, LLC |
| Other Organization Name | ORAL & FACIAL SURGERY OF WEST GEORGIA |
| Practice Address |
4405 N Stadium Drive Suite A Columbus GA 31909 |
| Mailing Address |
747 N Dean Road Auburn AL 36830 |
| Practice Telephone | 3347493436 |
| Practice Fax Number | 3347493233 |
| Mailing Telephone | 3347493436 |
| Mailing Fax Number | 3347493233 |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2017-12-08 |
| Authorized Official Name | THOMAS H FUQUA (MANAGING MEMBER) |
| Authorized Official Telephone | 3347493436 |
| Authorized Official Credential | DMD, MD |
| Is Organization Subpart | Y |
| Parent Organization Name | ORAL & FACIAL SURGERY OF EAST ALABAMA, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
MD28533 | AL | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003194410A | 05 |
| Other Name | Type Code |
|---|---|
| Oral & Facial Surgery of West Georgia | Doing Business As Name - Organization |
| Street Address |
4405 N STADIUM DRIVE SUITE A |
| City | COLUMBUS |
| State | GA |
| Zip Code | 31909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235747403 | Abundant Heart Healthcare Solution, LLC | Adult Companion | 6361 Talokas Lane, Ste C 140-279, Columbus, GA 31909 | 2020-07-14 |
| 1477185791 | Shandis Denise Phaneuf | Licensed Practical Nurse | 6545 Gregg Dr, Columbus, GA 31909 | 2020-02-05 |
| 1164086203 | Brock Musick | Physical Therapist | 100 First Court, Columbus, GA 31909 | 2019-04-24 |
| 1407340037 | Courtney Patterson | Behavior Technician | 5900 Warm Springs Road, Suite J, Columbus, GA 31909 | 2018-06-18 |
| 1528577368 | Courtney Anne Young | Nurse Practitioner | 2700 Double Churches Rd, Apt 1207, Columbus, GA 31909 | 2017-09-25 |
| 1427573542 | Megan Renee Kwon | Dietitian, Registered | 4343 Warm Springs Road Apt. 110, Columbus, GA 31909 | 2017-08-09 |
| 1942659305 | Stephanie Mcghee | Dental Hygienist | 4835 Turnberry Lane, Columbus, GA 31909 | 2016-06-07 |
| 1770932162 | Tammy Allen | Dental Assistant | 701 Hoff Rd Building 9240, Ft. Benning, GA 31909 | 2016-06-07 |
| 1003265406 | Rhonda Mills | Dental Assistant | 7101 Hoff Rd Building 9240, Ft. Benning, GA 31909 | 2016-06-07 |
| 1174971303 | Zoe Pediatric After Hours Care Inc | Clinic/Center | 3033 Williams Road, Columbus, GA 31909 | 2016-05-27 |
| Find all providers in zip 31909 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497140719 | Chelsea Elizabeth Johnson | Dentist | 4405 N Stadium Dr Ste A, Columbus, GA 31909-1884 | 2015-04-02 |
| 1275951972 | Oleg Kalsow | Dentist | 300 Hospital Dr Ste 4, Columbus, MS 39705 | 2014-03-31 |
| 1316176944 | Hany Emam | Dentist | 305 W 12th Ave Rm 2110, Columbus, OH 43210-1267 | 2009-07-02 |
| 1720222607 | Matthew Mcdonough | Dentist | 1501 Hilliard Rome Rd, Suite E, Columbus, OH 43228-9544 | 2009-04-23 |
| 1033389382 | Oral & Facial Surgery for Adults & Children LLC | Dentist | 1161 Bethel Rd Suite 303, Columbus, OH 43220-2775 | 2008-03-03 |
| 1003023870 | Columbus Oral & Maxillofacial Surgery PC | Dentist | 4405 N Stadium Dr, Suite A, Columbus, GA 31909-1878 | 2007-05-17 |
| 1629199526 | Rob S. Steiner | Dentist | 5350 E Main St, Columbus, OH 43213-2590 | 2007-04-02 |
| 1104982065 | William Frederick Schultz Jr. | Dentist | 2350 N Park Dr, Columbus, IN 47203-4466 | 2006-12-28 |
| 1437215308 | Phillip T Latham | Dentist | 4488 W Broad St, Columbus, OH 43228-5610 | 2006-12-28 |
| 1326123365 | Kent D Fischvogt | Dentist | 2350 Northpark, Columbus, IN 47203-4466 | 2006-10-26 |
| Find all providers in COLUMBUS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.