Provider Demographics
NPI:1225384365
Name:ROCKWELL, DAMION (DMD)
Entity type:Individual
Prefix:DR
First Name:DAMION
Middle Name:
Last Name:ROCKWELL
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 1:2220 WISTERIA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-4604
Mailing Address - Country:US
Mailing Address - Phone:229-392-3897
Mailing Address - Fax:
Practice Address - Street 1:2220 WISTERIA DR STE 300
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-4604
Practice Address - Country:US
Practice Address - Phone:678-836-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0148831223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1225384365Medicaid