MEDICARE: JAMES ISLAND FAMILY ORTHODONTICS LLC

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	261QD0000X	Dental Clinic/Center
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1215870027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES ISLAND FAMILY ORTHODONTICS LLC

Provider Business Mailing Address
First Line	:	2970 BRANDYWINE RD STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5549
Country	:	US
Telephone Number	:	770-692-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4105
Country	:	US
Telephone Number	:	843-818-5437
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	JO ANN RICE
Credential	:
Telephone Number	:	609-315-3851

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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