Individual provider Active NPI

Christopher Smith, DDS

  • Dentist
  • Mableton, GA
National Provider Identifier
1083074355
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN015432 Issued in GA
Practice address
4875 Floyd Rd SW Ste 113
Mableton, GA 30126-1379
Phone
(770) 732-0900
NPI assigned
Mar 1, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN015432 GA Primary

Addresses

Primary practice location

4875 Floyd Rd SW Ste 113
Mableton, GA 30126-1379

Mailing address

4875 Floyd Rd SW Ste 113
Mableton, GA 30126-1379
Phone (770) 732-0900

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171009002806 GA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3971878422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN015432GAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1456790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083074355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4875 FLOYD RD SW STE 113",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301261379",
            "telephone_number": "770-732-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4875 FLOYD RD SW STE 113",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301261379",
            "telephone_number": "770-732-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN015432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mableton, GA

Sources for this page

Verify at the official NPI Registry.