Active NPI
Sunday A Fawole, DDS, MD
- General Practice Dentistry
- Snellville, GA
National Provider Identifier
1164591913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DNO12698
- Practice address
- 2395 Scenic Hwy S
Snellville, GA 30078-3134 - Phone
- (678) 377-6830
- Fax
- (678) 377-6836
- NPI assigned
- Nov 7, 2006
- 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 |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 55514 | GA | |
| General Practice Dentistry | 1223G0001X | DNO12698 | GA | Primary |
Addresses
Primary practice location
2395 Scenic Hwy S
Snellville, GA 30078-3134
Mailing address
2395 Scenic Hwy S
Snellville, GA 30078-3134
Phone (678) 377-6830
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 586073644E | Medicaid | GA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DNO12698 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four Corners Primary Care Centers, Inc. | Past | Accepting new patients | |
| Four Corners Primary Care Centers, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Lawrenceville, GA
- NPI 1285325282
-
- Federally Qualified Health Center (FQHC)
- Lawrenceville, GA
- NPI 1356682959
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645401600000",
"number": "1164591913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2395 SCENIC HWY S",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300783134",
"telephone_number": "678-377-6830",
"fax_number": "678-377-6836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2395 SCENIC HWY S",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300783134",
"telephone_number": "678-377-6830",
"fax_number": "678-377-6836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAWOLE",
"first_name": "SUNDAY",
"middle_name": "A",
"credential": "DDS, MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2022-02-21",
"certification_date": "2022-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "GA",
"license": "55514",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DNO12698",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "586073644E",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Snellville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.