Active NPI
Jeffrey C. Dodson, D.D.S.
- General Practice Dentistry
- Conyers, GA
National Provider Identifier
1164577581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 010085
- Practice address
- 1807 Over Lake Dr SE
Conyers, GA 30013-1777 - Phone
- (770) 922-3131
- Fax
- (770) 860-9417
- NPI assigned
- Jan 24, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 010085 | GA | Primary |
Addresses
Primary practice location
1807 Over Lake Dr SE
Conyers, GA 30013-1777
Mailing address
1807 Over Lake Dr SE
Conyers, GA 30013-1777
Phone (770) 922-3131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010085 | GA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164577581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1807 OVER LAKE DR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300131777",
"telephone_number": "770-922-3131",
"fax_number": "770-860-9417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1807 OVER LAKE DR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300131777",
"telephone_number": "770-922-3131",
"fax_number": "770-860-9417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODSON",
"first_name": "JEFFREY",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "010085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.