East Atlanta Oral, Implant and Facial Surgery Center

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

EAST ATLANTA ORAL, IMPLANT AND FACIAL SURGERY CENTER

Practice address

519 Memorial Dr SE Unit D1
Atlanta, GA 30312-2218

Phone

(404) 483-6316

NPI assigned

May 24, 2018

Organization subpart

No

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

Authorized official

Name

Jeremy Tarver, DDS

Title

Owner

Phone

(770) 382-3536

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527120000000",
    "number": "1245721216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 WOLBERT TRL",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300627908",
            "telephone_number": "770-382-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 MEMORIAL DR SE UNIT D1",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303122218",
            "telephone_number": "404-483-6316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ATLANTA ORAL, IMPLANT AND FACIAL SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "last_updated": "2018-05-24",
        "status": "A",
        "authorized_official_last_name": "TARVER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-382-3536",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 May 24, 2018; 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.