Smile Source Atlanta East

LBN: Smile Source Atlanta East
Smile Source Atlanta East is an health care organization with primary practice located at 1147 S Hairston Rd Ste A , Stone Mountain GA 30088-2757. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty. Smile Source Atlanta East can be contacted via phone (678) 515-4200, or through Williams, Keonka M via phone (404) 897-1699.

Contact Information

Primary practice address
1147 S Hairston Rd Ste A Stone Mountain GA 30088-2757
Phone: (678) 515-4200
Fax: (678) 515-4201
Website:
Map and Directions
Authorized official contact:
Name: Williams, Keonka M
Phone: (404) 897-1699

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X

Profile Details

NPI number 1518622869
LBN Legal business name Smile Source Atlanta East
DBA Doing business as
Authorized official Williams, Keonka M
Entity Organization
Organization subpart 1 No
Enumeration date Nov 2nd, 2021
Last updated Nov 2nd, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518622869 NPPES
Georgia Other DN122249 GA BOARD OF DENTITSTRY
Georgia Other DN011069 GA BOARD OF DENTITSTRY

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