Southwest Maxillofacial Surgery & Implant Center

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN013463 Issued in GA

Legal business name

SOUTHWEST MAXILLOFACIAL SURGERY & IMPLANT CENTER

Practice address

3885 Princeton Lakes Way SW
406
Atlanta, GA 30331-5589

Phone

(404) 629-6610

Fax

(404) 629-6630

NPI assigned

Jul 15, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jacques Leonel Gordon, DMD

Title

President

Phone

(404) 629-6610

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raymond Charles Dickey Jr., DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Dallas, GA
  • NPI 1194168328
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247616000000",
    "number": "1073743795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3885 PRINCETON LAKES WAY SW",
            "address_2": "406",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315589",
            "telephone_number": "404-629-6610",
            "fax_number": "404-629-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3885 PRINCETON LAKES WAY SW",
            "address_2": "406",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315589",
            "telephone_number": "404-629-6610",
            "fax_number": "404-629-6630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MAXILLOFACIAL SURGERY & IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-15",
        "last_updated": "2009-07-15",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JACQUES",
        "authorized_official_middle_name": "LEONEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-629-6610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN013463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457061566A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southwest Atlanta Nephrology, PC
• Southwest Atlanta Podiatry, LLC
• Southwest Atlanta Vascular Care, LLC
• Southwest Atlanta Vascular Care, LLC
• Southwest Atlanta Vascular Care, LLC
• Sovereign Care Services LLC
• Sovereign Rehabilitation of Georgia, LLC (Centers for Orthopedic Rehabilitation)
• Sovereign Rehabilitation of Georgia, LLC (Centers for Orthopedic Rehab)
• Jaconna Sowell
• Ayomide Fiyinfoluwa Sowemimo, MD

• Oral and Maxillofacial Surgery (Dentist) in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.