# PDA SPECIALTY OF GEORGIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457853210
- **Authorized official:** ANNETTE MARLOW (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (724) 698-2119

## Contact information

- **Practice address:** 3466 COBB PKWY NW STE 170, ACWORTH, GA 30101-5768
- **Practice address phone:** (770) 203-1711
- **Mailing address:** 11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/07/2018
- **Last updated:** 03/17/2018