Shineille Blair, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN123140 Issued in GA

Practice address

719 Lanier Ave W
Fayetteville, GA 30214-7634

Phone

(770) 615-0999

Fax

(770) 731-2385

NPI assigned

Jun 30, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trinity Pediatric Medicine of Fayetteville

  • Pediatrics Physician
  • Atlanta, GA
  • NPI 1609247311
  NPD (past)

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1073290185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14500 SW 37TH ST",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330273789",
            "telephone_number": "954-358-7511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 LANIER AVE W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147634",
            "telephone_number": "770-615-0999",
            "fax_number": "770-731-2385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3695 Cascade Rd SW Ste V",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303312146",
            "country_code": "US",
            "telephone_number": "404-236-6024",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6175 Old National Hwy Ste 430",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303494470",
            "country_code": "US",
            "telephone_number": "678-228-8235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1607 White Way",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303443317",
            "country_code": "US",
            "telephone_number": "404-382-5845",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3050 Martin Luther King Jr Dr SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303111500",
            "country_code": "US",
            "telephone_number": "404-696-3163",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3890 Redwine Rd SW Ste 108",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303315583",
            "country_code": "US",
            "telephone_number": "404-586-4848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "SHINEILLE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN123140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.