Organization
GA SDS III PC
Active
Organization
GA SDS III PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE E VIAL (DIREC OF CRED AND PROV REL)
(504) 638-0303
Entity
Organization
Contact information
Practice address
91 W WIEUCA RD NE STE 300, ATLANTA, GA 30342-3248
(404) 303-7400
Mailing address
401 CHURCH ST STE 1400, NASHVILLE, TN 37219-2214
(504) 638-0303
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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