NPIMap

Organization Active NPI

Mableton Dental Inc

  • Dentist
  • Mableton, GA
National Provider Identifier
1164634440
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MABLETON DENTAL INC
Practice address
5841 Mableton Pkwy
Mableton, GA 30126
Phone
(770) 944-8700
Fax
(770) 819-1190
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Rollin B. Jackson Jr., DDS
Title
Dentist, Owner
Phone
(770) 944-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

5841 Mableton Pkwy
Mableton, GA 30126

Mailing address

PO Box 1159
Mableton, GA 30126
Phone (770) 944-8700

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164634440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1159",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "30126",
            "telephone_number": "770-944-8700",
            "fax_number": "770-819-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 MABLETON PKWY",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "30126",
            "telephone_number": "770-944-8700",
            "fax_number": "770-819-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MABLETON DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ROLLIN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "DENTIST, OWNER",
        "authorized_official_telephone_number": "770-944-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mableton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.