Healthcare Provider Details

I. General information

NPI: 1497720007
Provider Name (Legal Business Name): SMALL SMILES OF ATLANTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2006
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MARTIN LUTHER KING JR DR SW
ATLANTA GA
30311-1500
US

IV. Provider business mailing address

16 ARCADE UNIT 198747
NASHVILLE TN
37219-1994
US

V. Phone/Fax

Practice location:
  • Phone: 404-696-3163
  • Fax: 404-696-3165
Mailing address:
  • Phone: 615-750-0343
  • Fax: 615-986-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. JENELL STRINGER
Title or Position: MANAGER, LICENSING & CREDENTIALING
Credential:
Phone: 615-750-0343