Individual provider Active NPI

Malcolm Aaron Gossett, D.M.D

  • Dentist
  • Atlanta, GA
National Provider Identifier
1104378934
Registry record updated Oct 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN015308 Issued in GA
Practice address
2484 Briarcliff Rd NE Ste 29
Atlanta, GA 30329-3011
Phone
(404) 315-7385
NPI assigned
Oct 27, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN015308 GA Primary

Addresses

Primary practice location

2484 Briarcliff Rd NE Ste 29
Atlanta, GA 30329-3011

Mailing address

303 27TH Ave
Seattle, WA 98122-6129
Phone (404) 551-8011

Other practice location 1

1450 Ga 138
Conyers, GA 30013
Phone (770) 679-3544

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
I20170124000277 GA Order and Referring Only - DentistPractitioner - Dentist 0749562924

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1104378934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 27TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981226129",
            "telephone_number": "404-551-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2484 BRIARCLIFF RD NE STE 29",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303293011",
            "telephone_number": "404-315-7385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1450 Ga 138",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "30013",
            "country_code": "US",
            "telephone_number": "770-679-3544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOSSETT",
        "first_name": "MALCOLM",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-27",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN015308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.