Healthcare Provider Details

I. General information

NPI: 1013515709
Provider Name (Legal Business Name): PIEDMONT PERIODONTICS ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 12TH ST NE STE 1B
ATLANTA GA
30309-4009
US

IV. Provider business mailing address

222 12TH ST NE STE 1B
ATLANTA GA
30309-4009
US

V. Phone/Fax

Practice location:
  • Phone: 404-815-4800
  • Fax: 404-815-0002
Mailing address:
  • Phone: 404-815-4800
  • Fax: 404-815-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN W SCHAEFER
Title or Position: OWNER/PERIODONTIST
Credential: DMD
Phone: 404-815-4800