Organization
PERIODONTAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY LEON DIVERSI JR. DMD MSD (PRESIDENT)
(770) 996-2900
Entity
Organization
Contact information
Practice address
1895 PHOENIX BLVD, STE 138, ATLANTA, GA 30349
(770) 996-2900
(770) 996-0403
Mailing address
1895 PHOENIX BLVD, STE 138, ATLANTA, GA 30349
(770) 996-2900
(770) 996-0403
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6518
GA
Other
Enumeration date
05/02/2007
Last updated
08/22/2020
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