Provider Demographics
NPI:1386713154
Name:KEARNS, JANET KIM (DDS)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:KIM
Last Name:KEARNS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 CAROLINE ST NE
Mailing Address - Street 2:SUITE C 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2757
Mailing Address - Country:US
Mailing Address - Phone:404-889-8370
Mailing Address - Fax:404-889-8382
Practice Address - Street 1:1250 CAROLINE ST NE
Practice Address - Street 2:SUITE C 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2757
Practice Address - Country:US
Practice Address - Phone:404-889-8370
Practice Address - Fax:404-889-8382
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO130121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA122567435AMedicaid