Provider Demographics
NPI:1285764787
Name:CHARLES E ATKINS JR, DMD
Entity type:Organization
Organization Name:CHARLES E ATKINS JR, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORDECAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-329-3931
Mailing Address - Street 1:137 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1138
Mailing Address - Country:US
Mailing Address - Phone:662-329-3931
Mailing Address - Fax:
Practice Address - Street 1:1603 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3102
Practice Address - Country:US
Practice Address - Phone:601-483-4522
Practice Address - Fax:601-485-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1284-071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty