Provider Demographics
NPI:1710511738
Name:COLLETT, AMARA ALTMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMARA
Middle Name:ALTMAN
Last Name:COLLETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 ROSWELL RD STE D229
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4045
Mailing Address - Country:US
Mailing Address - Phone:770-530-7436
Mailing Address - Fax:
Practice Address - Street 1:5975 ROSWELL RD STE D229
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4045
Practice Address - Country:US
Practice Address - Phone:678-701-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0160551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice