Paul Ivey Nettles LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

6742 Issued in GA

Legal business name

PAUL IVEY NETTLES LLC

Practice address

1177 Garden Walk Blvd
College Park, GA 30349-6245

Phone

(770) 997-9090

NPI assigned

Jan 18, 2007

Organization subpart

No

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

Authorized official

Name

Paul I Nettles, DMD

Title

President

Phone

(770) 997-9090

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1063564078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 HIGHMEADE TER",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300053755",
            "telephone_number": "770-337-0976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 GARDEN WALK BLVD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303496245",
            "telephone_number": "770-997-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL IVEY NETTLES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "NETTLES",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-997-9090",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "11589",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "6742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0050949A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.