Provider Demographics
NPI:1194974097
Name:NINA N. CAREY DMD P.C.
Entity type:Organization
Organization Name:NINA N. CAREY DMD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CAREYLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-972-7214
Mailing Address - Street 1:1790 PRESIDENTIAL CIR STE B
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5688
Mailing Address - Country:US
Mailing Address - Phone:770-972-7214
Mailing Address - Fax:770-972-7254
Practice Address - Street 1:1790 PRESIDENTIAL CIR STE B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5688
Practice Address - Country:US
Practice Address - Phone:770-972-7214
Practice Address - Fax:770-972-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9180346OtherDORAL/WELLCARE