Organization
D4C OF GEORGIA LLC LISA SHILMAN SOLE MBR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANN RICE (CREDENTIALING MANAGER)
(609) 315-3851
Entity
Organization
Contact information
Practice address
5505 PEACHTREE DUNWOODY RD STE 470, ATLANTA, GA 30342-1717
(770) 692-1000
Mailing address
2970 BRANDYWINE RD STE 200, ATLANTA, GA 30341-5549
(770) 692-1000
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
11/30/2021
Last updated
11/30/2021
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