PERIODONTAL ASSOCIATES PC (NPI# 1184845273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184845273 |
| Entity Type | Organization |
| Organization Name | PERIODONTAL ASSOCIATES PC |
| Practice Address |
1895 Phoenix Blvd Ste 138 Atlanta GA 30349 |
| Practice Telephone | 7709962900 |
| Practice Fax Number | 7709960403 |
| Mailing Telephone | 7709962900 |
| Mailing Fax Number | 7709960403 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. HENRY LEON DIVERSI JR. (PRESIDENT) |
| Authorized Official Telephone | 7709962900 |
| Authorized Official Credential | DMD MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
6518 | GA | Dental Providers |
| Street Address |
1895 PHOENIX BLVD STE 138 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760640023 | Shelia Head | Social Worker | 1895 Phoenix Blvd, 166, Atlanta, GA 30349-5592 | 2008-05-22 |
| 1386798718 | Henry Leon Diversi Jr. | Dentist | 1895 Phoenix Blvd, Suite 138, Atlanta, GA 30349 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376185686 | Kmb Diagnostics | Durable Medical Equipment & Medical Supplies | 941 Flat Shoals Rd, Atlanta, GA 30349 | 2019-10-09 |
| 1114575859 | Justin Vassell | Registered Nurse | 1903 Phoenix Boulevard, Suite 200, College Park, GA 30349 | 2019-08-27 |
| 1841856663 | Kennyetta Danielle Watkins | Counselor | 1431 Riverwalk Ln, Apt. F, College Park, GA 30349 | 2019-05-16 |
| 1275002636 | Patriot Healthcare of Georgia, LLC | Family Medicine | 1587 Phoenix Boulevard, Suite 6, College Park, GA 30349 | 2018-11-15 |
| 1669971875 | Ee Consulting Solution | Case Management | 6320 Topaz Tral, Arlanta, GA 30349 | 2018-02-03 |
| 1629595640 | Shayla Bouie | Contractor | 5420 Riverdale Rd Apt D17, Atlanta, GA 30349 | 2017-08-30 |
| 1114475563 | Jasmine V Mccully | Social Worker | 5864 Summergien Lane, College Park, GA 30349 | 2016-09-14 |
| 1639537681 | Shelia Thornton | Counselor | 5856 Seabright Lane, Atlanta, GA 30349 | 2016-02-05 |
| 1346610177 | Joanne Resilard | Nurse Practitioner | 2931 Herron Ln Sw, Atlanta, GA 30349 | 2015-10-06 |
| 1063805091 | Southwest Atlanta Medical & Rehabilitation Clinic LLC | Family Medicine | 495 85 Circle, Suite 100, Atlanta, GA 30349 | 2015-03-16 |
| Find all providers in zip 30349 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073972584 | Kara Kramer | Dentist | 2970 Peachtree Rd Nw Ste 622, Atlanta, GA 30305-2115 | 2016-02-12 |
| 1699104927 | Nisha Maniar Kancherla | Dentist | 300 W Wieuca Rd Ne Suite 100, Atlanta, GA 30342-9701 | 2013-11-07 |
| 1306273172 | Gerrit Charles Hagman | Dentist | 6190 Rivercliffe Dr, Atlanta, GA 30328-3711 | 2013-10-10 |
| 1306188156 | Brock J Pumphrey I | Dentist | 999 Peachtree St Ne Ste 710, Atlanta, GA 30309-3964 | 2013-03-20 |
| 1760732697 | Maria Andreina Izarra | Dentist | 199 14th St Ne, #2205, Atlanta, GA 30309-3643 | 2012-09-18 |
| 1538370143 | Abe Shuster | Dentist | 999 Peachtree St, Suite 710, Atlanta, GA 30309-3915 | 2007-05-25 |
| 1962628776 | Frank P. Benson | Dentist | 6105 Peachtree Dunwoody Rd., Building C Suite 245, Atlanta, GA 30328 | 2007-04-18 |
| 1245351089 | Aubrey Scher | Dentist | 3648 Chamblee Tucker Rd, Atlanta, GA 30341-4403 | 2007-04-02 |
| 1386763464 | Mark Thomas Litterer | Dentist | 3648 Chamblee Tucker Rd Ste B, Atlanta, GA 30341-4403 | 2007-03-28 |
| 1326176991 | Piedmont Periodontics | Dentist | 222 12th Street, Suite 1b, Atlanta, GA 30309-5044 | 2007-03-02 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.