Active NPI
Randall Jerald Phillips, D.M.D.
- Dentist
- Gainesville, GA
National Provider Identifier
1104083997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN010821
- Practice address
- 516 Candler St
Gainesville, GA 30501-3332 - Phone
- (770) 536-1222
- NPI assigned
- May 20, 2008
- Sex
- Male
- Sole proprietor
- Yes
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN010821 | GA | MD | Dentist |
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 | DN010821 | GA | Primary |
Addresses
Primary practice location
516 Candler St
Gainesville, GA 30501-3332
Mailing address
516 Candler St
Gainesville, GA 30501-3332
Phone (770) 536-1222
NPI Registry JSON
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1104083997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "516 CANDLER ST",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013332",
"telephone_number": "770-536-1222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 CANDLER ST",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013332",
"telephone_number": "770-536-1222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "RANDALL",
"middle_name": "JERALD",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-20",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN010821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.