NPIMap

Organization Active NPI

Georgia Dental Professionals, PC

Doing business as Panola Family Dentistry

  • General Practice Dentistry
  • Stonecrest, GA
National Provider Identifier
1992479893
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Doing business as
Panola Family Dentistry
Practice address
2998 Panola Rd
Stonecrest, GA 30038-2394
Phone
(043) 228-0404
NPI assigned
Aug 4, 2021
Last updated
Aug 4, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA DENTAL PROFESSIONALS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2998 Panola Rd
Stonecrest, GA 30038-2394

Mailing address

2998 Panola Rd
Stonecrest, GA 30038-2394
Phone (043) 228-0404

Other names 1

  • Panola Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Georgia72 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Georgia

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

2998 Panola Rd
Stonecrest, GA 30038
Phone (770) 322-8040

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1992479893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2998 PANOLA RD",
            "city": "STONECREST",
            "state": "GA",
            "postal_code": "300382394",
            "telephone_number": "043-228-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2998 PANOLA RD",
            "city": "STONECREST",
            "state": "GA",
            "postal_code": "300382394",
            "telephone_number": "043-228-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panola Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stonecrest, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.