Provider Demographics
NPI:1730866468
Name:COLE, VIRGINIA MADDEN (DMD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MADDEN
Last Name:COLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-4233
Mailing Address - Country:US
Mailing Address - Phone:229-881-4454
Mailing Address - Fax:
Practice Address - Street 1:7371 BLACKMON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4478
Practice Address - Country:US
Practice Address - Phone:706-327-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1231041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice