NPI Code Detail JSON Logo

1619516002 NPI number — GEORGIA DENTAL ASSOCIATES, LLC

NPI Number: 1619516002
Health Care Provider/Practitioner: GEORGIA DENTAL ASSOCIATES, LLC

Information about “1619516002” NPI (GEORGIA DENTAL ASSOCIATES, LLC) exists in 1619516002 in HTML format HTML  |  1619516002 in plain Text format TXT  |  1619516002 in PDF (Portable Document Format) PDF  |  1619516002 in an XML format XML  formats.

NPI Number : 1619516002 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619516002",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "GEORGIA DENTAL ASSOCIATES",
    "ParentOrgTIN": null,
    "OrgName": "GEORGIA DENTAL ASSOCIATES, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "315 14TH ST E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TIFTON",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31794-4018",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "229-313-5083",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "315 14TH ST E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TIFTON",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31794-4018",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "229-313-5083",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/02/2020",
    "LastUpdateDate": "01/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HATCHER",
    "AuthorizedOfficialFirstName": "NETTIE",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "DIRECTOR OF  OPERATIONS",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "229-848-2685",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QD0000X",
        "TaxonomyName": "Dental Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.