| Atlanta Oral & Facial Surgery Llc | |
|
1000 Johnson Ferry Rd Bldg H Marietta GA 30068-2114 | |
| (770) 977-0364 | |
| (678) 483-8487 |
| Full Name | Atlanta Oral & Facial Surgery Llc |
|---|---|
| Speciality | Dentist |
| Location | 1000 Johnson Ferry Rd, Marietta, Georgia |
| Authorized Official Name and Position | Dana Leach (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7709770364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atlanta Oral & Facial Surgery Llc 1000 Johnson Ferry Rd Bldg H Marietta GA 30068-2114 Ph: (770) 977-0364 | Atlanta Oral & Facial Surgery Llc 1000 Johnson Ferry Rd Bldg H Marietta GA 30068-2114 Ph: (770) 977-0364 |
| NPI Number | 1992738165 |
|---|---|
| Provider Enumeration Date | 07/09/2006 |
| Last Update Date | 03/01/2024 |
| Medicare PECOS PAC ID | 8628062387 |
|---|---|
| Medicare Enrollment ID | O20040414000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992738165 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Chris Jo |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1114985389 PECOS PAC ID: 6901803659 Enrollment ID: I20061023000361 |
| Provider Name | Martin R Velez |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1154322535 PECOS PAC ID: 5698772457 Enrollment ID: I20061109000064 |
| Provider Name | Durwood M Johnson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1861505141 PECOS PAC ID: 2860593274 Enrollment ID: I20070728000047 |
| Provider Name | Richard P Keim |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1750331419 PECOS PAC ID: 9537250592 Enrollment ID: I20070806000066 |
| Provider Name | Antwan Treadway |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1972616878 PECOS PAC ID: 8820177793 Enrollment ID: I20080502000517 |
| Provider Name | Paul J Schaner |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1790789121 PECOS PAC ID: 3779654918 Enrollment ID: I20080617000037 |
| Provider Name | Robert K Mcghee |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1154410454 PECOS PAC ID: 1355479445 Enrollment ID: I20100511000650 |
| Provider Name | Stephen Anthony Bankston |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1235133661 PECOS PAC ID: 0143415638 Enrollment ID: I20101110000338 |
| Provider Name | Donald Ray Nunn |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1699779025 PECOS PAC ID: 8628264546 Enrollment ID: I20101118000005 |
| Provider Name | Steven Jule Levy |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1114921012 PECOS PAC ID: 8628265576 Enrollment ID: I20101206000227 |
| Provider Name | Richard Abraham Meaders |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1396749958 PECOS PAC ID: 2062609365 Enrollment ID: I20101213000900 |
| Provider Name | Erik David Belinfante |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1194720433 PECOS PAC ID: 2769679844 Enrollment ID: I20101215000711 |
| Provider Name | Robert Carl Wunderle |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1093718645 PECOS PAC ID: 1557559358 Enrollment ID: I20101221000385 |
| Provider Name | Henry K Blair |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1912165721 PECOS PAC ID: 8921270372 Enrollment ID: I20111007000550 |
| Provider Name | Jonathan M.c. Threadgill |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1093881021 PECOS PAC ID: 3779749361 Enrollment ID: I20120726000126 |
| Provider Name | Abtin Etezadi-tabrizi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1366601866 PECOS PAC ID: 6406003060 Enrollment ID: I20120904000653 |
| Provider Name | Thomas J David |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1275702870 PECOS PAC ID: 6901030758 Enrollment ID: I20131009001462 |
| Provider Name | Robert C Wunderle |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1437460011 PECOS PAC ID: 8729395314 Enrollment ID: I20150915000670 |
| Provider Name | Christopher Hugh Kragor |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1194082321 PECOS PAC ID: 9032420989 Enrollment ID: I20180925000002 |
| Provider Name | John P Labanc |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1104819101 PECOS PAC ID: 5698056281 Enrollment ID: I20181002000578 |
| Provider Name | Jorge A Gonzalez-ocasio |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1205192887 PECOS PAC ID: 1850634205 Enrollment ID: I20190528002169 |
| Provider Name | Joshua M Levy |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1528401445 PECOS PAC ID: 7810328291 Enrollment ID: I20200519002757 |
| Provider Name | Bryan M Benton |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1861884124 PECOS PAC ID: 8527478817 Enrollment ID: I20201027001441 |
| Provider Name | David L Cole |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1558895078 PECOS PAC ID: 2365846367 Enrollment ID: I20210813000327 |
| Provider Name | Wesley Scott Sherrell |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1851827158 PECOS PAC ID: 0042644684 Enrollment ID: I20210914003641 |
| Provider Name | Erin Shariff |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1306256151 PECOS PAC ID: 2769876127 Enrollment ID: I20220301000179 |
| Provider Name | Michael Hall |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1972008530 PECOS PAC ID: 1153702824 Enrollment ID: I20220713001651 |
| Provider Name | Sruthi Satishchandran |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1942797550 PECOS PAC ID: 9032555107 Enrollment ID: I20240312000345 |
| Provider Name | Salam Salman |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1154555035 PECOS PAC ID: 7315258464 Enrollment ID: I20240327003137 |
| Provider Name | Lewis John Dillard |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1124688841 PECOS PAC ID: 4082949334 Enrollment ID: I20240801003254 |
| Provider Name | Jacob A Lee |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1912438805 PECOS PAC ID: 1557632197 Enrollment ID: I20240805001927 |
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