Basic Information
| Provider Information | |||||||||
| NPI: | 1467712745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOTTLEY | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | WHITNEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6367 GOTHARDS LN | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301343643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706935316 | ||||||||
| FaxNumber: | 7706935316 | ||||||||
| Practice Location | |||||||||
| Address1: | 8505 HOSPITAL DR | ||||||||
| Address2: | SUITES 7 & 8 | ||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301342414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704896735 | ||||||||
| FaxNumber: | 7704896737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2012 | ||||||||
| LastUpdateDate: | 05/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DNO13779 | GA | Y | Dental Providers | Dentist |
No ID Information.