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2814 Buford Hwy Ne Brookhaven GA 30329-2103 | |
| (404) 486-7661 | |
| (404) 486-7662 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2814 Buford Hwy Ne, Brookhaven, Georgia |
| Authorized Official Name and Position | Anita Gordon (OWNER) |
| Authorized Official Contact | 4044867661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 29411 Atlanta GA 30359-0411 Ph: (404) 486-7661 | 2814 Buford Hwy Ne Brookhaven GA 30329-2103 Ph: (404) 486-7661 |
| NPI Number | 1528435203 |
|---|---|
| Provider Enumeration Date | 08/28/2015 |
| Last Update Date | 08/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528435203 | NPI | - | NPPES |
| 000225299A | Medicaid | GA | |
| 00809278A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN009248 (Georgia) | Primary |
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