Active NPI
Lee Atkinson
- Periodontics
- Jacksonville, FL
National Provider Identifier
1124488762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 019.030160
- Practice address
- 554 Kelly Street
Bureau of Medicine and Surgery
Jacksonville, FL 32212 - Phone
- (760) 719-4747
- NPI assigned
- Feb 24, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.030160 | IL | |
| Periodontics | 1223P0300X | 019.030160 | IL | Primary |
Addresses
Primary practice location
554 Kelly Street
Bureau of Medicine and Surgery
Jacksonville, FL 32212
Mailing address
554 Kelly Street
Bureau of Medicine and Surgery
Jacksonville, FL 32212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 14, 2024 through May 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.030160 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695081600000",
"number": "1124488762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "554 KELLY STREET",
"address_2": "BUREAU OF MEDICINE AND SURGERY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "554 KELLY STREET",
"address_2": "BUREAU OF MEDICINE AND SURGERY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32212",
"telephone_number": "760-719-4747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ATKINSON",
"first_name": "LEE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-24",
"last_updated": "2023-09-19",
"certification_date": "2023-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.030160",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "019.030160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.