Active NPI
Amon A Meadows, DMD
- Dentist
- Smyrna, GA
National Provider Identifier
1073785820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11763
- Practice address
- 4686 S Atlanta Rd SE
Suite I
Smyrna, GA 30080-7080 - Phone
- (404) 799-8499
- Fax
- (404) 799-8496
- NPI assigned
- Apr 1, 2008
- 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 | 11763 | GA | Primary |
Addresses
Primary practice location
4686 S Atlanta Rd SE
Suite I
Smyrna, GA 30080-7080
Mailing address
4686 S Atlanta Rd SE
Suite I
Smyrna, GA 30080-7080
Phone (404) 799-8499
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00772461D | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11763 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207008000000",
"number": "1073785820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4686 S ATLANTA RD SE",
"address_2": "SUITE I",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300807080",
"telephone_number": "404-799-8499",
"fax_number": "404-799-8496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4686 S ATLANTA RD SE",
"address_2": "SUITE I",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300807080",
"telephone_number": "404-799-8499",
"fax_number": "404-799-8496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEADOWS",
"first_name": "AMON",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-01",
"last_updated": "2008-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "11763",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00772461D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.