Pda Specialty of Georgia, LLC

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

Legal business name

PDA SPECIALTY OF GEORGIA, LLC

Practice address

3466 Cobb Pkwy NW Ste 170
Acworth, GA 30101-5768

Phone

(770) 203-1711

NPI assigned

Mar 7, 2018

Last updated

Mar 17, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Annette Marlow

Title

Credentialing Supervisor

Phone

(724) 698-2119

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Bahareh Emadzadeh Nia, D.M.D.

  • General Practice Dentistry
  • Atlanta, GA
  • NPI 1578799789
  NPD (past)

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1457853210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3466 COBB PKWY NW STE 170",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015768",
            "telephone_number": "770-203-1711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1867 Jonesboro Rd Ste 6",
            "address_purpose": "LOCATION",
            "city": "McDonough",
            "state": "GA",
            "postal_code": "302536099",
            "country_code": "US",
            "telephone_number": "678-432-0209",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3230 Lawrence Suwanee Rd",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "30024",
            "country_code": "US",
            "telephone_number": "770-224-0140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5304 Windward Pkwy",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "300043827",
            "country_code": "US",
            "telephone_number": "770-777-1911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4374 Atlanta Hwy Ste 109",
            "address_purpose": "LOCATION",
            "city": "Hiram",
            "state": "GA",
            "postal_code": "301411849",
            "country_code": "US",
            "telephone_number": "770-505-9898",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4353 Atlanta Hwy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300523232",
            "country_code": "US",
            "telephone_number": "770-450-2030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "740 Ferst Drive NW Suite 207",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303220001",
            "country_code": "US",
            "telephone_number": "404-733-2022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10373 Industrial Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "GA",
            "postal_code": "300141403",
            "country_code": "US",
            "telephone_number": "678-306-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PDA SPECIALTY OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "724-698-2119"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Payne, D.C.
• Candice Denise Payne, HOME HEALTH AID
• Kimberly Kristen Payne
• Kyle J Payne, DPT
• Pda Ortho Specialty of Georgia, LLC
• Pediatric Therapy Solutions of Georgia, LLC
• Hannah Pepper
• Moya Claire Perez, MSW
• Carrie Yvonne Perkins
• Anna Perry, LMFCT, TF-CBT, DBT

• Oral and Maxillofacial Pathology Dentistry in Acworth, GA
• Providers in Acworth, GA by specialty
• Oral and Maxillofacial Pathology Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.