Jeremiah Bancroft

Primary specialty

ContractorTaxonomy code 171W00000X

Practice address

62 Industrial Park Rd
Dawsonville, GA 30534-6654

Phone

(678) 894-2762

NPI assigned

Aug 19, 2021

Last updated

Aug 19, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1124794128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 INDUSTRIAL PARK RD",
            "city": "DAWSONVILLE",
            "state": "GA",
            "postal_code": "305346654",
            "telephone_number": "678-894-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 INDUSTRIAL PARK RD",
            "city": "DAWSONVILLE",
            "state": "GA",
            "postal_code": "305346654",
            "telephone_number": "678-894-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANCROFT",
        "first_name": "JEREMIAH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeremiah@moldtestcompany.com",
            "affiliation": "N",
            "endpointDescription": "email adress",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "62 Industrial Park Rd",
            "city": "Dawsonville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305346654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Contractor in Dawsonville, GA
• Providers in Dawsonville, GA by specialty
• Contractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.