Southwest Oral and Maxillofacial Surgery,LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DNO12915 Issued in GA

Legal business name

SOUTHWEST ORAL AND MAXILLOFACIAL SURGERY,LLC

Practice address

620 Pointe North Boulevard
Albany, GA 31721

Phone

(678) 350-6566

NPI assigned

Dec 24, 2009

Last updated

Dec 24, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brad J Harris, D.M.D.

Title

Sole Member/Oral Surgeon

Phone

(678) 350-6566

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261612800000",
    "number": "1023347937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4896",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301140026",
            "telephone_number": "678-350-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 POINTE NORTH BOULEVARD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "31721",
            "telephone_number": "678-350-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST ORAL AND MAXILLOFACIAL SURGERY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-24",
        "last_updated": "2009-12-24",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SOLE MEMBER/ORAL SURGEON",
        "authorized_official_telephone_number": "678-350-6566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DNO12915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southwest Georgia Pediatrics
• Southwest Health District 8-2
• Southwestern Emergency Physicians PC
• Southwestern Homecare & Medical Services Inc
• Southwestern State Hospital (Assertive Community Treatment Program)
• Southwestern State Hospital
• Sowega Anesthesia, LLC

• Oral and Maxillofacial Surgery (Dentist) in Albany, GA
• Providers in Albany, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.