Healthcare Provider Details

I. General information

NPI: 1710015789
Provider Name (Legal Business Name): MICHAEL J MCDEVITT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PIEDMONT RD NE SUITE 120
ATLANTA GA
30305-1506
US

IV. Provider business mailing address

3580 PIEDMONT RD NE SUITE 120
ATLANTA GA
30305-1506
US

V. Phone/Fax

Practice location:
  • Phone: 404-231-1080
  • Fax: 404-231-8719
Mailing address:
  • Phone: 404-231-1080
  • Fax: 404-231-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7762
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: