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General NPI Number Information
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NPI Number | 1386590487
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Entity Type | Organization
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Legal Business Name | S23 OF GEORGIA, LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 3111 PIEDMONT RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2507
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Country | US
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Telephone | 404-261-5388
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 PIEDMONT RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | DEWONNA LEWIS
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Credential |
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Telephone | 404-246-9567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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