MEDICARE: CHILDREN AND TEEN ORTHO GROUP OF ALABAMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1063969368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN AND TEEN ORTHO GROUP OF ALABAMA

Provider Business Mailing Address
First Line	:	2300 LAKEVIEW PKWY STE 250
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-3954
Country	:	US
Telephone Number	:	470-207-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 RICE MINE RD NE STE 260
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-2401
Country	:	US
Telephone Number	:	205-758-3341
Fax Number	:	678-550-5490

Authorized Official
Title or Position	:	CEO
Name	:	BRIAN SMITH
Credential	:
Telephone Number	:	470-207-3264

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	05/21/2026

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