Provider Demographics
NPI:1427327923
Name:PEARLS OF HEALTH MEDICAL AND DENTAL, LLC
Entity type:Organization
Organization Name:PEARLS OF HEALTH MEDICAL AND DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:NICOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-306-4457
Mailing Address - Street 1:7580 SPRINGBOX DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1287
Mailing Address - Country:US
Mailing Address - Phone:770-306-4457
Mailing Address - Fax:770-774-7218
Practice Address - Street 1:7580 SPRINGBOX DR
Practice Address - Street 2:SUITE 250
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1287
Practice Address - Country:US
Practice Address - Phone:770-306-4457
Practice Address - Fax:770-774-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty