Provider Demographics
NPI:1023327822
Name:NORTH GEORGIA ORAL SURGERY, P.C.
Entity type:Organization
Organization Name:NORTH GEORGIA ORAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:NADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-591-9555
Mailing Address - Street 1:6304 OLD HIGHWAY 5
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2443
Mailing Address - Country:US
Mailing Address - Phone:770-591-9555
Mailing Address - Fax:770-591-9595
Practice Address - Street 1:6304 OLD HIGHWAY 5
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2443
Practice Address - Country:US
Practice Address - Phone:770-591-9555
Practice Address - Fax:770-591-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054425261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery