Provider Demographics
NPI:1770031544
Name:CHATTAHOOCHEE FAMILY ORTHODONTICS
Entity Type:Organization
Organization Name:CHATTAHOOCHEE FAMILY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-231-5348
Mailing Address - Street 1:342 N MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8376
Mailing Address - Country:US
Mailing Address - Phone:770-888-7798
Mailing Address - Fax:
Practice Address - Street 1:345 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 1102
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8819
Practice Address - Country:US
Practice Address - Phone:770-888-7798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty