Classic City Orthodontics

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

012101 Issued in GA

Legal business name

CLASSIC CITY ORTHODONTICS

Practice address

600 Oglethorpe Ave
Athens, GA 30606-2263

Phone

(706) 549-4748

Fax

(706) 705-1650

NPI assigned

Nov 9, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Carla Robin Oliver

Title

Insurance Coordinator

Phone

(706) 549-4748

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447027200000",
    "number": "1609249903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 OGLETHORPE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062263",
            "telephone_number": "706-549-4748",
            "fax_number": "706-705-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 OGLETHORPE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062263",
            "telephone_number": "706-549-4748",
            "fax_number": "706-705-1650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLASSIC CITY ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-09",
        "last_updated": "2015-11-09",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "ROBIN",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "706-549-4748",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "GA",
            "license": "012101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1669591947",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Classic City Counseling & Consultation LLC
• Classic City Dialysis Inc
• Classic City Home Care LLC
• Classic City Internal Medicine
• Classic City OBGYN LLC
• Classic City Rehab LLC
• Classic City Surgical Assistants LLC
• Rachel Corinne Clay, D.D.S.
• George Cleland, MD
• Nicholas Benjamin Clemmons

• Exclusive Provider Organization in Athens, GA
• Providers in Athens, GA by specialty
• Exclusive Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; 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.