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General NPI Number Information
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NPI Number | 1013515709
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Entity Type | Organization
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Legal Business Name | PIEDMONT PERIODONTICS ATLANTA LLC
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 222 12TH ST NE STE 1B
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City | ATLANTA
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State | GA
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Zip | 30309-4009
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Country | US
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Telephone | 404-815-4800
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Fax | 404-815-0002
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Provider Business Mailing Address
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Address Line | 222 12TH ST NE STE 1B
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City | ATLANTA
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State | GA
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Zip | 30309-4009
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Country | US
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Telephone | 404-815-4800
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Fax | 404-815-0002
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Authorized Official
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Title or Position | OWNER/PERIODONTIST
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Name | DR. JOHN W SCHAEFER
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Credential | DMD
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Telephone | 404-815-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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