Active NPI
Henry Leon Diversi Jr., DMD MSD
- Periodontics
- Atlanta, GA
National Provider Identifier
1386798718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 6518
- Practice address
- 1895 Phoenix Blvd
Suite 138
Atlanta, GA 30349 - Phone
- (770) 996-2900
- Fax
- (770) 996-0403
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 6518 | GA | Primary |
Addresses
Primary practice location
1895 Phoenix Blvd
Suite 138
Atlanta, GA 30349
Mailing address
1895 Phoenix Blvd
Suite 138
Atlanta, GA 30349
Phone (770) 996-2900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6518 | GA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Periodontal Associates PC | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Periodontics
- Atlanta, GA
- NPI 1184845273
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386798718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1895 PHOENIX BLVD",
"address_2": "SUITE 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": "SUITE 138",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30349",
"telephone_number": "770-996-2900",
"fax_number": "770-996-0403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIVERSI",
"first_name": "HENRY",
"middle_name": "LEON",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "GA",
"license": "6518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
- Dili Priya Divakaran, PT
- Dive Therapy & Consulting LLC
- Diverse Counseling & Psychological Associates, LLC
- Diverse Counseling & Psychological Associates, LLC
- Diverse Images Management Services LLC,
- Diversity ABA
- Varada Dinkar Divgi, M.B.B.S. FAAP
- Divine Behavioral Services
- Divine Dermatology & Aesthetics LLC
- Divine Inclination Psychotherapy and Consulting, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.