Provider Demographics
NPI:1134682859
Name:NORTH ATLANTA ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NORTH ATLANTA ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JEADEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-664-6533
Mailing Address - Street 1:3275 MARKET PLACE BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7981
Mailing Address - Country:US
Mailing Address - Phone:770-406-2060
Mailing Address - Fax:
Practice Address - Street 1:2555 WESTSIDE PKWY STE 350
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4191
Practice Address - Country:US
Practice Address - Phone:770-664-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Single Specialty