Provider Demographics
NPI:1194136929
Name:ARNOLD, JIMMY W (DMD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:W
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N CREST BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1847
Mailing Address - Country:US
Mailing Address - Phone:478-757-9620
Mailing Address - Fax:
Practice Address - Street 1:152 N CREST BLVD STE A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1847
Practice Address - Country:US
Practice Address - Phone:478-757-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0111891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics