Healthcare Provider Details

I. General information

NPI: 1326479544
Provider Name (Legal Business Name): JAWOMFS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GALLERIA PKWY SE SUITE 800
ATLANTA GA
30339-5992
US

IV. Provider business mailing address

425 PEACHTREE PKWY. SUITE 340
CUMMING GA
30041
US

V. Phone/Fax

Practice location:
  • Phone: 404-433-8433
  • Fax: 866-571-1330
Mailing address:
  • Phone: 404-433-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN013474
License Number StateGA

VIII. Authorized Official

Name: DR. ABTIN SHAHRIARI
Title or Position: OWNER / ORAL SURGEON
Credential: DMD
Phone: 404-433-8433