OrganizationActive
Oral an Implant Surgery Specialists, PC
NPI 1396094074 · Oral & Maxillofacial Surgery (D.M.D.) · Fayetteville, GA
Provider details
- NPI number
- 1396094074
- Entity type
- Organization
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)Allopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Durwood Johnson, Doctor(770) 461-2101
- License
- 007973 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1260 Highway 54 W
Suite 200
Fayetteville, GA 30214-4514
Phone: (770) 461-2101
Fax: (770) 460-1292
Approximate (ZIP-level) locationGet directions
Mailing address
1260 Highway 54 W
Fayetteville, GA 30214-4514
Registry dates
- Enumerated
- 2012-09-10
- Last updated
- 2013-05-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.