Provider Demographics
NPI:1982061123
Name:MHMC ORTHODONTICS OF ATLANTA, LLC
Entity Type:Organization
Organization Name:MHMC ORTHODONTICS OF ATLANTA, LLC
Other - Org Name:THE GEORGIA SCHOOL OF ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:
Authorized Official - Last Name:SINHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, BDS, MS
Authorized Official - Phone:509-869-0999
Mailing Address - Street 1:8200 ROBERTS DR
Mailing Address - Street 2:SUITE 550
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4147
Mailing Address - Country:US
Mailing Address - Phone:770-351-7737
Mailing Address - Fax:678-638-6201
Practice Address - Street 1:8200 ROBERTS DR
Practice Address - Street 2:SUITE 550
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4147
Practice Address - Country:US
Practice Address - Phone:770-351-7737
Practice Address - Fax:678-638-6201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MHA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0150841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty