Individual provider Active NPI

Daniel William Pidgeon Jr., D.C.

  • Chiropractor
  • Douglasville, GA
National Provider Identifier
1093885964
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6419 Issued in GA
Practice address
4900 Stewart Mill Rd.
Suite D
Douglasville, GA 30135-6725
Phone
(678) 838-0313
Fax
(678) 838-0306
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6419 GA Primary

Addresses

Primary practice location

4900 Stewart Mill Rd.
Suite D
Douglasville, GA 30135-6725

Mailing address

4900 Stewart Mill Rd.
Suite D
Douglasville, GA 30135-6725
Phone (678) 838-0313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110824000516 GA Practitioner - Chiropractic 1850561184 Practice locations: Douglasville, GA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4900 Stewart Mill Rd
Douglasville, GA 30135-6724
Phone (678) 838-0313

4900 Stewart Mill Rd
Suite D
Douglasville, GA 30135-6725

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6419GAMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093885964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 STEWART MILL RD.",
            "address_2": "SUITE D",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301356725",
            "telephone_number": "678-838-0313",
            "fax_number": "678-838-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 STEWART MILL RD.",
            "address_2": "SUITE D",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301356725",
            "telephone_number": "678-838-0313",
            "fax_number": "678-838-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIDGEON",
        "first_name": "DANIEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "6419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.