Provider Demographics
NPI:1245075670
Name:PETER A PATE, DDS, LLC
Entity type:Organization
Organization Name:PETER A PATE, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-229-4527
Mailing Address - Street 1:3675 HADDON HALL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2627
Mailing Address - Country:US
Mailing Address - Phone:404-229-4527
Mailing Address - Fax:404-506-9030
Practice Address - Street 1:91 W WIEUCA RD NE STE 4000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3291
Practice Address - Country:US
Practice Address - Phone:404-266-9424
Practice Address - Fax:404-506-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental