Active NPI
Malcolm Aaron Gossett, D.M.D
- Dentist
- Atlanta, GA
National Provider Identifier
1104378934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN015308
- 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
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 | 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170124000277 | GA | Order and Referring Only - 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.