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General NPI Number Information
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NPI Number | 1639977820
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Entity Type | Organization
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Legal Business Name | CHATTAHOOCHEE FAMILY ORTHODONTICS
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 313 MOOTY BRIDGE RD STE 202
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City | LAGRANGE
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State | GA
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Zip | 30240-1809
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Country | US
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Telephone | 706-837-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 LAKEVIEW PKWY STE 250
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City | ALPHARETTA
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State | GA
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Zip | 30009-3954
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Country | US
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Telephone | 470-207-3264
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MGR
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Name | NICOLE CARIDE
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Credential |
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Telephone | 727-784-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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