Healthcare Provider Details

I. General information

NPI: 1093610156
Provider Name (Legal Business Name): GEORGIA SURGICAL ARTS DENTAL IMPLANTS & ORAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 PEACHTREE ST NE STE 250
ATLANTA GA
30309-1881
US

IV. Provider business mailing address

1801 PEACHTREE ST NE STE 250
ATLANTA GA
30309-1881
US

V. Phone/Fax

Practice location:
  • Phone: 470-645-9500
  • Fax: 470-747-8674
Mailing address:
  • Phone: 470-645-9500
  • Fax: 470-747-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENN HERITAGE
Title or Position: CREDENTIALING MANGER
Credential:
Phone: 405-805-4516