Periodontal Center of Georgia, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

PERIODONTAL CENTER OF GEORGIA, PC

Practice address

1920 Ga-20
Suite B
Conyers, GA 30013-2048

Phone

(770) 767-0603

Fax

(770) 929-4387

NPI assigned

Jan 22, 2024

Organization subpart

No

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

Authorized official

Name

Brittany Bennett

Title

Office Manager

Phone

(770) 922-8733

Specialties & licenses 1

Addresses

Other names 1

• Periodontal Center of Georgia Doing business as

Locations

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1639930118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 GA-20",
            "address_2": "SUITE B",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132048",
            "telephone_number": "770-767-0603",
            "fax_number": "770-929-4387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 GA-20",
            "address_2": "SUITE B",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132048",
            "telephone_number": "770-767-0603",
            "fax_number": "770-929-4387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL CENTER OF GEORGIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-922-8733"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Periodontal Center of Georgia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Periodontal Center of Georgia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Periodontics in Conyers, GA
• Providers in Conyers, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.