Provider Demographics
NPI:1013515709
Name:PIEDMONT PERIODONTICS ATLANTA LLC
Entity Type:Organization
Organization Name:PIEDMONT PERIODONTICS ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-815-4800
Mailing Address - Street 1:222 12TH ST NE STE 1B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4009
Mailing Address - Country:US
Mailing Address - Phone:404-815-4800
Mailing Address - Fax:404-815-0002
Practice Address - Street 1:222 12TH ST NE STE 1B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4009
Practice Address - Country:US
Practice Address - Phone:404-815-4800
Practice Address - Fax:404-815-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental