Provider Demographics
NPI:1407551906
Name:RAWLS, JEROME LEONARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:LEONARD
Last Name:RAWLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 ROSWELL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6295
Mailing Address - Country:US
Mailing Address - Phone:770-282-3719
Mailing Address - Fax:
Practice Address - Street 1:3823 ROSWELL RD STE 205
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6295
Practice Address - Country:US
Practice Address - Phone:770-282-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1235591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice