MEDICARE: SMILE 23 OF GEORGIA PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1578331880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE 23 OF GEORGIA PC

Provider Business Mailing Address
First Line	:	3111 PIEDMONT RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2507
Country	:	US
Telephone Number	:	404-261-5388
Fax Number	:	404-237-5799

Provider Business Practice Location Address
First Line	:	3111 PIEDMONT RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2507
Country	:	US
Telephone Number	:	404-261-5388
Fax Number	:	404-237-5799

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. CHARLES FREEDMAN
Credential	:	DDS
Telephone Number	:	404-261-5388

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	12/15/2023

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