Provider Demographics
NPI:1306441753
Name:NOVUS ORTHODONTICS OF GEORGIA LLC
Entity type:Organization
Organization Name:NOVUS ORTHODONTICS OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-986-7116
Mailing Address - Street 1:300 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3524
Mailing Address - Country:US
Mailing Address - Phone:770-487-8298
Mailing Address - Fax:770-487-5372
Practice Address - Street 1:300 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3524
Practice Address - Country:US
Practice Address - Phone:770-487-8298
Practice Address - Fax:770-487-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty