Active NPI
Michelle S Gwyn
- General Practice Dentistry
- Macon, GA
National Provider Identifier
1023083631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN013195
- Practice address
- 1536 Eisenhower Pkwy
Macon, GA 31206-3130 - Phone
- (478) 781-4333
- NPI assigned
- Feb 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN013195 | GA | Primary |
Addresses
Primary practice location
1536 Eisenhower Pkwy
Macon, GA 31206-3130
Mailing address
415 N Grand Ave
Pueblo, CO 81003-3111
Phone (719) 546-3333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9180516 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN013195 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1023083631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 N GRAND AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810033111",
"telephone_number": "719-546-3333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1536 EISENHOWER PKWY",
"city": "MACON",
"state": "GA",
"postal_code": "312063130",
"telephone_number": "478-781-4333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWYN",
"first_name": "MICHELLE",
"middle_name": "S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-18",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN013195",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9180516",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.