Smile Source Atlanta East
NPI 1518622869ActiveOrganization· Dentist, General Practice· Stone Mountain, GA
Dentist, General Practice in Stone Mountain, Georgia, registered in NPPES in November 2021. The authorized official on file is Keonka M. Williams, Business Manager.
Overview
| NPI | 1518622869 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 2, 2021 |
| Last updated in NPPES | Nov 2, 2021 |
| Certified by provider | Nov 2, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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