PDA SPECIALTY OF GEORGIA, LLC (NPI# 1457853210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457853210 |
| Entity Type | Organization |
| Organization Name | PDA SPECIALTY OF GEORGIA, LLC |
| Practice Address |
3466 Cobb Pkwy Nw Ste 170 Acworth GA 30101-5768 |
| Mailing Address |
11 S Mill St Ste 200 New Castle PA 16101-3680 |
| Practice Telephone | 7702031711 |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | ANNETTE MARLOW (CREDENTIALING SUPERVISOR) |
| Authorized Official Telephone | 7246982119 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 740 Ferst Drive Nw Suite 207, Atlanta, GA 303220001 | 4047332022 | |
| 10373 Industrial Blvd Ne, Covington, GA 300141403 | 6783066000 | |
| 4353 Atlanta Hwy Ste 300, Loganville, GA 300523232 | 7704502030 | |
| 3230 Lawrence Suwanee Rd, Suite 300, Suwanee, GA 30024 | 7702240140 | |
| 4374 Atlanta Hwy Ste 109, Hiram, GA 301411849 | 7705059898 | |
| 5304 Windward Pkwy, Alpharetta, GA 300043827 | 7707771911 | |
| 1867 Jonesboro Rd Ste 6, Mcdonough, GA 302536099 | 6784320209 |
| Street Address |
3466 COBB PKWY NW STE 170 |
| City | ACWORTH |
| State | GA |
| Zip Code | 30101-5768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861900946 | Professional Dental Alliance of Georgia, LLC | Dentist | 3466 Cobb Pkwy Nw Ste 170, Acworth, GA 30101-5768 | 2018-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952931552 | A3j Incorporated | Registered Nurse | 3905 Cobb Pkwy Nw Ste 305, Acworth, GA 30101 | 2020-01-22 |
| 1043869852 | Sharron Leigh Lipscomb | Acupuncturist | 3661 Cedarcrest Rd Ste 320, Acworth, GA 30101 | 2019-09-05 |
| 1699322933 | Cowry Home Dialysis LLC | Durable Medical Equipment & Medical Supplies | 4450 Calibre Crossings Nw, Suite # 1122, Acworth, GA 30101 | 2019-08-21 |
| 1760979595 | Sandra Jeanetta Pugh | Counselor | 118 Clubhouse Crossing, Acworth, GA 30101 | 2018-04-17 |
| 1679926950 | Cindy Hatfield Fruits | Psychologist | 4839 N. Main Street, Acworth, GA 30101 | 2016-07-21 |
| 1396192563 | Philip Young | Specialist/Technologist | 4841 Lake Park Lane, Acworth, GA 30101 | 2016-05-18 |
| 1770960619 | Karen Fuller | Marriage & Family Therapist | 2487 Cedarcrest Rd Ste 722, Acworth, GA 30101 | 2015-04-29 |
| 1366830333 | Willard Hogan IIi | Physician Assistant | 1720 Mars Hill Rd Nw Ste 8-175, Acworth, GA 30101 | 2014-12-29 |
| 1386042083 | Sebastian Diaz Fischer | Chiropractor | 2639 Hickory Grove Rd, Suit 150, Ackworth, GA 30101 | 2014-12-11 |
| 1841699337 | J Chappell Md PC | Dermatology | 4450 Calibre Crossings, Suite 1208, Acworth, GA 30101 | 2014-08-20 |
| Find all providers in zip 30101 | ||||
| Taxonomy Code | 1223P0106X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Pathology |
| The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740375500 | William D Campbell | Dentist | 1818 Warm Springs Rd, Columbus, GA 31904 | 2006-10-04 |
| 1891880720 | William H. Wall | Dentist | 5139 Jimmy Carter Blvd Ste 201, Norcross, GA 30093-1638 | 2006-10-04 |
| 1366546376 | Zoya B Kurago | Dentist | 1120 15th St Dept Of, Augusta, GA 30912 | 2006-09-11 |
| 1235248170 | Robert M Lazerson | Dentist | 3020 Roswell Rd, Suite 110, Marietta, GA 30062-4996 | 2006-08-30 |
| 1811000268 | William Paisley Hines | Dentist | 1587 Vernon Rd, Lagrange, GA 30240-4146 | 2006-08-17 |
| 1245267749 | Joel Martin Adler | Dentist | Joel M. Adler, Dds, 2677 Ridge Valley Rd Nw, Atlanta, GA 30327 | 2006-06-28 |
| 1780649202 | Stephanie Joy Drew | Dentist | 1365 Clifton Rd Ne Ste 2300, Atlanta, GA 30322-4405 | 2006-04-18 |
| 1023016748 | Michael Alan Kahn | Dentist | 2701 N. Decatur Rd., Decatur, GA 30033-5918 | 2005-07-08 |
| 1629073465 | Eric D Ferrara | Dentist | 614 S 8th St, Griffin, GA 30224-4214 | 2005-06-17 |
| 1932521481 | Ximena Zornosa | Dentist | 428 Winn Ct, Decatur, GA 30030-1726 | 2014-01-16 |
| Find all providers with the same taxonomy | ||||
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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.