Provider Demographics
NPI:1801246525
Name:AUSTIN, JAMIE GRANT (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:GRANT
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 POINTE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4652
Mailing Address - Country:US
Mailing Address - Phone:770-475-3600
Mailing Address - Fax:
Practice Address - Street 1:11775 POINTE PL STE 101
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4652
Practice Address - Country:US
Practice Address - Phone:770-475-3600
Practice Address - Fax:770-475-8666
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO151821223G0001X
GADN015182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN015182OtherGEORGIA BOARD OF DENTISTRY