Healthcare Provider Details

I. General information

NPI: 1437063591
Provider Name (Legal Business Name): MS. SIMWERAY S. KAWALIE-FATAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIPE KAWALIE

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 HOWELL MILL RD SUITE 221
ATLANTA GA
30327
US

IV. Provider business mailing address

3280 HOWELL MILL RD SUITE 221
ATLANTA GA
30327
US

V. Phone/Fax

Practice location:
  • Phone: 404-220-7505
  • Fax: 404-815-7730
Mailing address:
  • Phone: 404-220-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: