SOUTHWEST MAXILLOFACIAL SURGERY & IMPLANT CENTER (NPI# 1073743795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073743795 |
| Entity Type | Organization |
| Organization Name | SOUTHWEST MAXILLOFACIAL SURGERY & IMPLANT CENTER |
| Practice Address |
3885 Princeton Lakes Way Sw 406 Atlanta GA 30331-5589 |
| Practice Telephone | 4046296610 |
| Practice Fax Number | 4046296630 |
| Mailing Telephone | 4046296610 |
| Mailing Fax Number | 4046296630 |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2009-07-15 |
| Authorized Official Name | DR. JACQUES LEONEL GORDON (PRESIDENT) |
| Authorized Official Telephone | 4046296610 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN013463 | GA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 457061566A | 05 |
| Street Address |
3885 PRINCETON LAKES WAY SW 406 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30331-5589 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811989478 | Lisa C Perry-gilkes | Otolaryngology | 3885 Princeton Lakes Way Sw, Suite 312a, Atlanta, GA 30331-5589 | 2005-08-19 |
| 1861933178 | Southwest Atlanta Vascular Care, LLC | Radiology | 3885 Princeton Lakes Way Sw, Suite 314, Atlanta, GA 30331-5589 | 2017-03-20 |
| 1598127540 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 3885 Princeton Lakes Way Sw, Atlanta, GA 30331-5589 | 2016-03-28 |
| 1326409566 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 3885 Princeton Lakes Way Sw, Suite 225, Atlanta, GA 30331-5589 | 2016-03-16 |
| 1811357080 | S.val Plastic Surgery P.C. | Plastic Surgery | 3885 Princeton Lakes Way Sw, Suite 312, Atlanta, GA 30331-5589 | 2016-03-02 |
| 1366841744 | Southern Crescent Physicians Group, Inc | Psychiatry & Neurology | 3885 Princeton Lakes Way Sw, Atlanta, GA 30331-5589 | 2014-08-21 |
| 1205267192 | Wellstar Medical Group, LLC | Internal Medicine | 3885 Princeton Lakes Way Sw, Suite 300, Atlanta, GA 30331-5589 | 2013-12-03 |
| 1942548870 | Ispm Asc At Camp Creek LLC | Clinic/Center | 3885 Princeton Lakes Way Sw, Ste 400, Atlanta, GA 30331-5589 | 2013-01-28 |
| 1447594106 | Ispm Asc At Camp Creek LLC | Clinic/Center | 3885 Princeton Lakes Way Sw, Suite 400, Atlanta, GA 30331-5589 | 2012-11-19 |
| 1356685390 | Camp Creek LLC | Specialist | 3885 Princeton Lakes Way Sw, Ste 400, Atlanta, GA 30331-5589 | 2012-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861001174 | Whitney Flemister | Social Worker | 3961 Princeton Lakes Way Sw, Atlanta, GA 30331 | 2020-07-23 |
| 1982237400 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 5829 Campbellton Road, S.w, Suite 110, Atlanta, GA 30331 | 2020-02-13 |
| 1295375558 | Drusilla Precious Cudjoe | Behavior Technician | 3800 Camp Creek Parkway Sw, Building 1400, Atlanta, GA 30331 | 2020-01-14 |
| 1497262778 | Champions Pharmacy | Pharmacy | 3886 Princeton Lakes Way Suite 180, Atlanta, GA 30331 | 2018-01-08 |
| 1033629779 | Carmen Ardoin | Counselor | 2636 Martin Luther King Jr. Drive, Suite 12, Atlanta, GA 30331 | 2017-10-09 |
| 1346759974 | Neva R Allison | Nurse Practitioner | 2611 Dayview Ln, Atlanta, GA 30331 | 2017-09-26 |
| 1538678255 | Natalie Mckay | Technician/Technologist | 3915 Cascade Rd, 220, Atlanta, GA 30331 | 2017-09-26 |
| 1700304268 | Tyrone Pipkin | Contractor | 415 Kendrick Terrace Sw, Atlanta, GA 30331 | 2017-09-05 |
| 1073031688 | Kristen Wooldridge | Pharmacist | 3695 Cascade Road, Atlanta, GA 30331 | 2017-09-04 |
| 1548704687 | Advance Pain Management | Health Maintenance Organization | 2950 Stone Hogan Road Connector, Atlanta, GA 30331 | 2016-12-08 |
| Find all providers in zip 30331 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649740796 | Sandy Springs Oral Surgery, LLC | Dentist | 5555 Peachtree Dunwoody Rd Ste G56, Atlanta, GA 30342-1700 | 2018-12-02 |
| 1245721216 | East Atlanta Oral, Implant and Facial Surgery Center | Dentist | 519 Memorial Dr Se Unit D1, Atlanta, GA 30312-2218 | 2018-05-24 |
| 1497261960 | Rockwell Oral and Facial Surgery LLC | Dentist | 675 N. Highland Ave Ne, Suite 100, Atlanta, GA 30306 | 2017-12-20 |
| 1194271445 | Dina Amin | Dentist | 1365 Clifton,building B, Oral and Maxillofacial Surgery, Suite 2300, Atlanta, GA 30322 | 2016-08-28 |
| 1841697539 | Brittney Barrow | Dentist | 60 11th St Ne Apt 2021, Atlanta, GA 30309-4388 | 2014-11-25 |
| 1083889661 | Amy Diane Kuhmichel | Dentist | 3280 Howell Mill Rd Nw Ste 221, Atlanta, GA 30327-4100 | 2008-04-24 |
| 1255517769 | Abtin Shahriari | Dentist | 182 Robin Hood Rd Ne, Atlanta, GA 30309-2658 | 2008-01-15 |
| 1033153671 | Joyce T Lee | Dentist | 1175 Peachtree St Ne, Suite 1202, Atlanta, GA 30361-6202 | 2006-06-15 |
| 1063471324 | Peachtree Oral & Maxillofacial Surgery Associates | Dentist | 550 Pharr Rd Ne, Suite 325, Atlanta, GA 30305-3428 | 2006-03-23 |
| 1134123524 | Lee Mclean Whitesides | Dentist | 5576 Chamblee-dunwoody Rd, Atlanta, GA 30338 | 2005-06-13 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.