Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kennestone Periodontics of Marietta, PC

Organization Periodontics · NPI 1316243389

Kennestone Periodontics of Marietta, PC is a Periodontics in Marietta, Georgia. Licensed in Georgia. Registered with an NPI since 2011.

Licensed in
GA
In the registry since
2011
Specialties on file
2
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

611 Campbell Hill St NW Ste 102
Marietta, GA 30060-1386
Phone: (770) 422-0642
Fax: (770) 422-0643
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X · Licence 10742 (GA)
Periodontics Taxonomy 1223P0300X · Licence 11384 (GA)

Record details

NPI number1316243389
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Peter Shatz — President · (770) 422-0642
NPI enumeratedFebruary 8, 2011
Last updated in NPPESFebruary 8, 2011
Mailing address2070 S Park Pl Se, Suite 200, Atlanta, GA 30339-2045

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