Provider Demographics
NPI:1326886722
Name:PIERSON, MOLLY MARIE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:PIERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2441
Mailing Address - Country:US
Mailing Address - Phone:706-629-0131
Mailing Address - Fax:
Practice Address - Street 1:201 S PARK AVE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2441
Practice Address - Country:US
Practice Address - Phone:706-629-0131
Practice Address - Fax:706-629-0299
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist