Provider Demographics
NPI:1780653972
Name:TARTT CALLIER, KAREN M (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:TARTT CALLIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 DECATUR ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1848
Mailing Address - Country:US
Mailing Address - Phone:678-843-8500
Mailing Address - Fax:404-633-0502
Practice Address - Street 1:3367 BUFORD HWY NE
Practice Address - Street 2:SUITE910
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1833
Practice Address - Country:US
Practice Address - Phone:678-843-8700
Practice Address - Fax:404-633-0502
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0118271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000852156AMedicaid
GA000852156EMedicaid