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Provider Information for 1992180111

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1992180111

Calendar   Last Updated:  2015-07-29
  Certification Date: 


Name Value
NPI 1992180111
Enumeration Date 2015-07-29
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 478 LINDBERGH PL NE APT. NO. 262
ATLANTA, GA 30324-3313
United States

Phone: 267-283-8288 | Fax:
View Map External Link
Primary Practice Address 4450 HUGH HOWELL RD SUITE #19
TUCKER, GA 30084-4727
United States

Phone: 770-938-9090 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice GA DN015061