Organization
SMILE SOURCE ATLANTA EAST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KEONKA M WILLIAMS (BUSINESS MANAGER)
(404) 897-1699
Entity
Organization
Contact information
Practice address
1147 S HAIRSTON RD STE A, STONE MOUNTAIN, GA 30088-2757
(678) 515-4200
(678) 515-4201
Mailing address
1100 PEACHTREE ST NE STE 680, ATLANTA, GA 30309-4516
(404) 897-1699
(404) 897-1599
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN011069
GA BOARD OF DENTISTRY
GA
01
—
DN122249
GA BOARD OF DENTITSTRY
GA
Enumeration date
11/02/2021
Last updated
11/02/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us