| Smile Source Atlanta East | |
|
1147 S Hairston Rd Ste A Stone Mountain GA 30088-2757 | |
| (678) 515-4200 | |
| (678) 515-4201 |
| Full Name | Smile Source Atlanta East |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1147 S Hairston Rd Ste A, Stone Mountain, Georgia |
| Authorized Official Name and Position | Keonka M Williams (BUSINESS MANAGER) |
| Authorized Official Contact | 4048971699 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Source Atlanta East 1100 Peachtree St Ne Ste 680 Atlanta GA 30309-4516 Ph: (404) 897-1699 | Smile Source Atlanta East 1147 S Hairston Rd Ste A Stone Mountain GA 30088-2757 Ph: (678) 515-4200 |
| NPI Number | 1518622869 |
|---|---|
| Provider Enumeration Date | 11/02/2021 |
| Last Update Date | 11/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518622869 | NPI | - | NPPES |
| DN122249 | Other | GA | GA BOARD OF DENTITSTRY |
| DN011069 | Other | GA | GA BOARD OF DENTISTRY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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