Active NPI
Kenneth D Pilgrim, DMD
- Dentist
- Flintstone, GA
National Provider Identifier
1073606703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9189
- Practice address
- 4787 Happy Valley Road
Flintstone, GA 30725 - Phone
- (706) 820-0413
- Fax
- (706) 820-4108
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 9189 | GA | Primary |
Addresses
Primary practice location
4787 Happy Valley Road
Flintstone, GA 30725
Mailing address
P. O. Box 217
4787 Happy Valley Road
Flintstone, GA 30725
Phone (706) 820-0413
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00205158A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160106000541 | GA | Order and Referring Only - Oral Surgery | 1951603000 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9189 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073606703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P. O. BOX 217",
"address_2": "4787 HAPPY VALLEY ROAD",
"city": "FLINTSTONE",
"state": "GA",
"postal_code": "30725",
"telephone_number": "706-820-0413",
"fax_number": "706-820-4108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4787 HAPPY VALLEY ROAD",
"city": "FLINTSTONE",
"state": "GA",
"postal_code": "30725",
"telephone_number": "706-820-0413",
"fax_number": "706-820-4108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PILGRIM",
"first_name": "KENNETH",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "9189",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00205158A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flintstone, GA
- Tia Miranda Gable, NP
- Stanley M Ireland, MD
- Kendra B. Keith, NP
- Lookout Mountain Community Services
- Marvin L. Mills, M.D., P.C.
- Reconciliation Therapy and Consulting, LLC
- Trilogy Integrated Health Care, Inc. of Georgia (Flintstone Family Health and Urgent Care Clinic)
- Heather Stottlemyre Tye Wall, MDIV, MACMH, LPC
- Dorrit Renee Zeigler
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.