Periodontal Associates PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6518 Issued in GA

Legal business name

PERIODONTAL ASSOCIATES PC

Practice address

1895 Phoenix Blvd
Ste 138
Atlanta, GA 30349

Phone

(770) 996-2900

Fax

(770) 996-0403

NPI assigned

May 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Henry Leon Diversi Jr., DMD MSDNPI 1386798718

Title

President

Phone

(770) 996-2900

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Henry Leon Diversi Jr., DMD MSD

  • Periodontics
  • Atlanta, GA
  • NPI 1386798718
  NPD (past) Authorized official
• Jennifer Irene Diversi, DMD

  • Periodontics
  • Stockbridge, GA
  • NPI 1568683654
  NPD (past)

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184845273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1895 PHOENIX BLVD",
            "address_2": "STE 138",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30349",
            "telephone_number": "770-996-2900",
            "fax_number": "770-996-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 PHOENIX BLVD",
            "address_2": "STE 138",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30349",
            "telephone_number": "770-996-2900",
            "fax_number": "770-996-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIVERSI",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-996-2900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "6518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perimeter Spine & Rehabilitation Center LLC
• Perimeter Spine and Rehabilitation LLC
• Perimeter Therapy Associates LLC
• Perimeter Vision Care, LLC (Atlanta Eye Group Tucker)
• Perimeter Vision Care, LLC (Atlanta Eye Group)
• Periodontal Specialists of Vinings
• Dylan Perito
• Cecil Katherine Perkerson, PA-C
• Casey Michelle Perkins
• Clint Perkins

• Periodontics in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.