Justin K Mack, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN124374 Issued in GA

Practice address

10377 Industrial Blvd NE
Covington, GA 30014-1403

Phone

(770) 222-2322

NPI assigned

Apr 29, 2026

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pda Ortho Specialty of Georgia, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Acworth, GA
  • NPI 1982169173
  NPD (past)

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

{
    "created_epoch": "1777420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1760328884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4256 TILLY MILL RD APT 2415",
            "city": "DORAVILLE",
            "state": "GA",
            "postal_code": "303603282",
            "telephone_number": "901-834-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10377 INDUSTRIAL BLVD NE",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300141403",
            "telephone_number": "770-222-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "JUSTIN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-04-29",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN124374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lumi ABA LLC
• Carlene Lynch
• Margaret Blanche Lyons, FNP
• M. Michael Pulliam, M.D., P.C. (Pulliam Eye Group/Newton Rockdale ASC)
• Candra Lanette Mack, M.D.
• Macmillz Mobile Medi Assessments LLC
• Andrew Maddox
• Made New Counseling, LLC
• Made New Counseling, LLC
• Sabrina Madison, BSN, RN

• Orthodontics and Dentofacial Orthopedics Dentistry in Covington, GA
• Providers in Covington, GA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; 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.