SRD Athens, PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SRD ATHENS, PLLC

Doing business as

SRD Athens

Practice address

22026 Gateway Blvd
Suites a
Athens, AL 35613

Phone

(256) 383-8037

NPI assigned

Nov 8, 2022

Last updated

Nov 22, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christyn Shields

Title

Controller

Phone

(256) 320-5903

Specialties & licenses 1

Addresses

Other names 1

• SRD Athens Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1053029116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E 5TH ST",
            "city": "TUSCUMBIA",
            "state": "AL",
            "postal_code": "356742410",
            "telephone_number": "256-383-4990",
            "fax_number": "265-383-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22026 GATEWAY BLVD",
            "address_2": "SUITES A",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "35613",
            "telephone_number": "256-383-8037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRD ATHENS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "CHRISTYN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "256-320-5903"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRD Athens",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SRD Athens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Athens, AL
• Providers in Athens, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.