SOUTH DEKALB DENTAL CENTER LLC (NPI# 1386795805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386795805 |
| Entity Type | Organization |
| Organization Name | SOUTH DEKALB DENTAL CENTER LLC |
| Practice Address |
2853 Candler Rd Suite 101 Decatur GA 30034-1433 |
| Practice Telephone | 4042441166 |
| Practice Fax Number | 4042441191 |
| Mailing Telephone | 4042441166 |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | WILLIAM ANDREW LITTON (VICE PRESIDENT) |
| Authorized Official Telephone | 6788791177 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | Managed Care Organizations |
| Street Address |
2853 CANDLER RD SUITE 101 |
| City | DECATUR |
| State | GA |
| Zip Code | 30034-1433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649614025 | Decatur Rehab Center, LLC | Chiropractor | 2853 Candler Rd, Suite 5, Decatur, GA 30034-1433 | 2013-04-29 |
| 1205076163 | C. Simone Evans | Chiropractor | 2853 Candler Rd, Suite 5, Decatur, GA 30034-1433 | 2009-03-04 |
| 1730353921 | Total Renal Care Inc | Clinic/Center | 2853 Candler Rd, Ste 203, Decatur, GA 30034-1421 | 2008-04-17 |
| 1912175530 | Irving Russell | Chiropractor | 2853 Candler Rd, Suite 5, Decatur, GA 30034-1433 | 2008-02-17 |
| 1316099005 | Donald Jerome Campbell | Dentist | 2853 Candler Rd, Suite 101, Decatur, GA 30034-1433 | 2007-01-16 |
| 1982756672 | George Francis Policastro Jr. | Dentist | 2853 Candler Rd, Suite 101, Decatur, GA 30034-1433 | 2007-01-16 |
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|---|---|---|---|---|
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| 1447876768 | Rosemary Maines | Recreation Therapist | The Maines Group LLC Dba Maines Health and Wellness, 3461 Jessica Run, Decatur, GA 30034 | 2020-06-23 |
| 1437775764 | The Maines Group, LLC | Adult Companion | The Maines Group, LLC Dba Maines Health and Wellness, 3461 Jessica Run, Decatur, GA 30034 | 2020-06-23 |
| 1801351994 | Anthony E. Parrish, D.d.s., PC | Dentist | 3653 Flakes Mill Road, Suite E, Deactur, GA 30034 | 2019-02-04 |
| 1164916813 | Lenina O Chi-ukpai | Nurse Practitioner | 2942 Secretariat Ct, Decatur, GA 30034 | 2018-06-17 |
| 1154662765 | Zackery Kanel Thomas | Driver | 2782 Green Marsh Court, Decatur, GA 30034 | 2013-03-06 |
| 1033472642 | Lakeba Hibbler Williams | Counselor | 4147 Flat Shoals Pkwy, Decatur, GA 30034 | 2012-06-19 |
| 1164789632 | Foot Solutions of Georgia | Durable Medical Equipment & Medical Supplies | 3011 S Rainbow Dr, Suite 160, Decatur, GA 30034 | 2012-04-20 |
| 1699096172 | Wanda P Garrett | Social Worker | 3013 Rainbow Drive, Suite 112-e, South Dekalb Office Park, Decatur, GA 30034 | 2010-06-18 |
| 1245558022 | Teresa Behrend Fletcher | Counselor | 3915 Brookside Pkwy, Decatur, GA 30034 | 2010-05-04 |
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| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
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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.