Provider Demographics
NPI:1154029114
Name:MCDOWELL & CO., LLC
Entity type:Organization
Organization Name:MCDOWELL & CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-884-9195
Mailing Address - Street 1:146 CREEKRISE PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2096
Mailing Address - Country:US
Mailing Address - Phone:404-884-9195
Mailing Address - Fax:
Practice Address - Street 1:865 S CARROLL RD STE C
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-7056
Practice Address - Country:US
Practice Address - Phone:770-459-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN15411OtherGA DENTAL LICENSE