Southern Peach Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTHERN PEACH DENTAL PC

Practice address

171 Cleveland Ave SW
Atlanta, GA 30315-8258

Phone

(678) 794-6966

NPI assigned

Nov 22, 2025

Organization subpart

No

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

Authorized official

Name

David McKellarNPI 1871454785

Title

Cfo

Phone

(678) 794-6966

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.

• David J McKellar

  • Dental Hygienist
  • Atlanta, GA
  • NPI 1871454785
  NPD Authorized official

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

{
    "created_epoch": "1763769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763769600000",
    "number": "1508727157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 CLEVELAND AVE SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303158258",
            "telephone_number": "678-794-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 CLEVELAND AVE SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303158258",
            "telephone_number": "678-794-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PEACH DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-22",
        "last_updated": "2025-11-22",
        "certification_date": "2025-11-22",
        "status": "A",
        "authorized_official_last_name": "MCKELLAR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "678-794-6966"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Atlanta, GA
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2025; 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.