Provider Demographics
NPI:1699863449
Name:ATWELL, GEORGE FRED JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FRED
Last Name:ATWELL
Suffix:JR
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 1:901 LEIGHTON AVENUE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207
Mailing Address - Country:US
Mailing Address - Phone:256-236-6090
Mailing Address - Fax:256-236-0713
Practice Address - Street 1:901 LEIGHTON AVENUE
Practice Address - Street 2:SUITE 401
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-236-6090
Practice Address - Fax:256-236-0713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36521223S0112X
GA78351223S0112X
FL59651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T68642Medicare UPIN