NPIMap

Organization Active NPI

Fogg/Zareie Enterprises Inc.

Doing business as Athens Family Dental Center

  • General Practice Dentistry
  • Athens, GA
National Provider Identifier
1114198108
Registry record updated Mar 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
006805 Issued in GA
Legal business name
FOGG/ZAREIE ENTERPRISES INC.
Doing business as
Athens Family Dental Center
Practice address
3380 Old Jefferson Rd
Athens, GA 30607-1480
Phone
(706) 548-3279
Fax
(706) 546-6475
NPI assigned
Mar 18, 2008
Last updated
Mar 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2008

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

Authorized official

Name
Mr. Robert Samuel Fogg
Title
Business Manager
Phone
(706) 548-3279

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 009000 GA
General Practice Dentistry 1223G0001X 006805 GA Primary

Addresses

Primary practice location

3380 Old Jefferson Rd
Athens, GA 30607-1480

Mailing address

3380 Old Jefferson Rd
Athens, GA 30607-1480
Phone (706) 548-3279

Other identifiers 4

IdentifierTypeStateIssuer
00508065AMedicaidGA
00862705AMedicaidGA
00176778CMedicaidGA
00915516AMedicaidGA

Other names 1

  • Athens Family Dental Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1114198108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 OLD JEFFERSON RD",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306071480",
            "telephone_number": "706-548-3279",
            "fax_number": "706-546-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 OLD JEFFERSON RD",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306071480",
            "telephone_number": "706-548-3279",
            "fax_number": "706-546-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOGG/ZAREIE ENTERPRISES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-18",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "FOGG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "706-548-3279",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "009000",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "006805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00508065A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00862705A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00176778C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00915516A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athens Family Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.

Verify at the official NPI Registry.