Provider Demographics
NPI:1285871012
Name:MCDONALD, EDWARD D'WITT (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D'WITT
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2463 HAMILTON MILL PKWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4648
Mailing Address - Country:US
Mailing Address - Phone:770-932-6510
Mailing Address - Fax:770-932-6511
Practice Address - Street 1:2463 HAMILTON MILL PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4648
Practice Address - Country:US
Practice Address - Phone:770-932-6510
Practice Address - Fax:770-932-6511
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA847469223CMedicaid