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NPI
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1265450126
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10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
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Entity Type
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Organization
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Code describing the type of health care provider that is being assigned an NPI. Codes are:
- 1 = (Person): individual human being who furnishes health care;
- 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
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Employer Identification Number (EIN)
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N/A
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The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. An Employer Identification Number (EIN) is assigned by the Internal Revenue Service (IRS) to identify a business entity. It may or may not be that business entity's Taxpayer Identification Number (TIN). An SSN should not be entered in the EIN field.
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Provider Organization Name (Legal Business Name)
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WILLOW POINT DENTAL ART CENTER
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Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
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Provider First Line Business Mailing Address
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6233 VETERANS PKWY
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The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
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Provider Business Mailing Address City Name
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COLUMBUS
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The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
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Provider Business Mailing Address State Name
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GA
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The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
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Provider Business Mailing Address Postal Code
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31909-3539
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The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
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Provider Business Mailing Address Country Code
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US
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The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
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Provider Business Mailing Address Telephone Number
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706-327-3364
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The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
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Provider Business Mailing Address Fax Number
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706-327-1103
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The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
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Provider First Line Business Practice Location Address
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6233 VETERANS PKWY
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The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
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Provider Business Practice Location Address City Name
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COLUMBUS
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The city name in the location address of the provider being identified.
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Provider Business Practice Location Address State Name
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GA
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The State or Province name in the location address of the provider being identified.
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Provider Business Practice Location Address Postal Code
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31909-3539
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The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
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Provider Business Practice Location Address Country Code
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US
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The country code in the location address of the provider being identified.
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Provider Business Practice Location Address Telephone Number
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706-327-3364
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The telephone number associated with the location address of the provider being identified.
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Provider Business Practice Location Address Fax Number
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706-327-1103
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The fax number associated with the location address of the provider being identified.
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Provider Enumeration Date
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07/18/2006
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The date the provider was assigned a unique identifier (assigned an NPI).
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Last Update Date
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07/08/2007
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The date that a record was last updated or changed.
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Authorized Official Last Name
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NARDE
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The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
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Authorized Official First Name
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JOSEPH
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The first name of the authorized official
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Authorized Official Middle Name
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A.
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The middle name of the authorized official
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Authorized Official Title or Position
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PRESIDENT
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The title or position of the authorized official
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Authorized Official Name Prefix Text
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DR.
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Authorized Official Name Prefix Text
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Authorized Official Credential Text
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D.D.S.
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Authorized Official Credential Text
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Authorized Official Telephone Number
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706-327-3364
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The 10-position telephone number of the authorized official.
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Healthcare Provider Taxonomy Code #1
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1223G0001X
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The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
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Healthcare Provider Taxonomy 1
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General Practice
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Healthcare Provider Taxonomy #1
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Provider License Number 1
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011256
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Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
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Provider License Number State Code 1
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GA
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Provider License Number State Code #1
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Healthcare Provider Primary Taxonomy Switch 1
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X
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Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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Healthcare Provider Taxonomy Code 2
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1223X0400X
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Healthcare Provider Taxonomy Code #2
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Healthcare Provider Taxonomy 2
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Orthodontics and Dentofacial Orthopedics
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Healthcare Provider Taxonomy #2
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Provider License Number 2
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011256
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Provider License Number #2
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Provider License Number State Code 2
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GA
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Provider License Number State Code #2
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Healthcare Provider Primary Taxonomy Switch 2
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X
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Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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Healthcare Provider Taxonomy Group 1
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193200000X MULTI-SPECIALTY GROUP
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Healthcare Provider Taxonomy Group 1
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Healthcare Provider Taxonomy Group Description 1
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Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.
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Healthcare Provider Taxonomy Group Description 1
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Healthcare Provider Taxonomy Group 2
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193200000X MULTI-SPECIALTY GROUP
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Healthcare Provider Taxonomy Group 2
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Healthcare Provider Taxonomy Group Description 2
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Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.
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Healthcare Provider Taxonomy Group Description 2
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