Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Kennestone Periodontics of Marietta, PC

Organization Periodontics · NPI 1316243389

Kennestone Periodontics of Marietta, PC provides 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 Not confirmed with CMS for 15 years — call before visiting
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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