MEDICARE: GA SDS III 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1861255093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GA SDS III PC

Provider Business Mailing Address
First Line	:	1610 54TH AVE N STE 205
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-1442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 W WIEUCA RD NE STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3248
Country	:	US
Telephone Number	:	404-303-7400
Fax Number	:

Authorized Official
Title or Position	:	DIREC OF CRED AND PROV REL
Name	:	CHARLOTTE V DASCH
Credential	:
Telephone Number	:	504-638-0303

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

Similar Medicare Providers

1164371233 — CHILDREN'S DENTISTRY OF CHASTAIN LLC
Practice Location Address:

91 W WIEUCA RD NE STE 400
ATLANTA, GA
30342-3248

Practice Phone: 770-971-5536
Practice Fax: 770-971-3046

1891819652 — DR. MICHAEL HARLEY SEBASTIAN DMD, MSD, PC
Practice Location Address:

91 W WIEUCA RD NE , SUITE-300
ATLANTA, GA
30342-3248

Practice Phone: 404-303-7400
Practice Fax: 404-303-1555

1245400514 — BUCKHEAD CONCIERGE INTERNAL MEDICINE, LLC
Practice Location Address:

91 W WIEUCA RD NE , SUITE 1000
ATLANTA, GA
30342-3248

Practice Phone: 404-257-5585
Practice Fax: 404-257-9985

1508639535 — GA SDS III PC
Practice Location Address:

91 W WIEUCA RD NE STE 300
ATLANTA, GA
30342-3248

Practice Phone: 404-303-7400
Practice Fax:

1386525475 — ELEANOR HEALTH PROFESSIONAL TX, PLLC
Practice Location Address:

1372 PEACHTREE ST. NE , OFFICE #333
ATLANTA, GA
30309-3248

Practice Phone: 781-487-1107
Practice Fax:

1063463461 — DR. WAYNE KURT MILLER D.C.
Practice Location Address:

731 AKERS RIDGE DR SE
ATLANTA, GA
30339-3248

Practice Phone: 404-781-2225
Practice Fax: 404-781-2226

Directions to “GA SDS III PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.