NPIMap

Organization Active NPI

Pediatric Dentistry of Central Georgia - Macon LLC

  • Pediatric Dentistry
  • Macon, GA
National Provider Identifier
1073083127
Registry record updated Dec 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PEDIATRIC DENTISTRY OF CENTRAL GEORGIA - MACON LLC
Practice address
5437 Bowman Rd Ste 300
Macon, GA 31210-6575
Phone
(478) 333-3636
NPI assigned
Dec 3, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2018

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

Authorized official

Name
Mrs. Shannon Battle
Title
Practice Manager
Phone
(478) 333-3636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

5437 Bowman Rd Ste 300
Macon, GA 31210-6575

Mailing address

900 Professional Dr
Warner Robins, GA 31088-0520
Phone (478) 333-3636

National Provider Directory

National Provider Directory

Locations

5437 Bowman Rd
Ste 300
Macon, GA 31210
Phone (478) 333-3636

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1073083127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 PROFESSIONAL DR",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310880520",
            "telephone_number": "478-333-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5437 BOWMAN RD STE 300",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312106575",
            "telephone_number": "478-333-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF CENTRAL GEORGIA - MACON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2018-12-03",
        "status": "A",
        "authorized_official_last_name": "BATTLE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "478-333-3636",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Dec 3, 2018; 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.