Active NPI
Mitchel S Godat, D.D.S.
- Periodontics
- Memphis, TN
National Provider Identifier
1174652671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 7731
- Practice address
- 6268 Poplar Ave
Memphis, TN 38119-4713 - Phone
- (901) 761-3770
- Fax
- (901) 761-3775
- NPI assigned
- Mar 2, 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 7731 | TN | Primary |
Addresses
Primary practice location
6268 Poplar Ave
Memphis, TN 38119-4713
Mailing address
6268 Poplar Ave
Memphis, TN 38119-4713
Phone (901) 761-3770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 21, 2016 through Jun 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7731 | TN | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Periodontal Associates of Memphis | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Periodontics
- Memphis, TN
- NPI 1023158185
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174652671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6268 POPLAR AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381194713",
"telephone_number": "901-761-3770",
"fax_number": "901-761-3775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6268 POPLAR AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381194713",
"telephone_number": "901-761-3770",
"fax_number": "901-761-3775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GODAT",
"first_name": "MITCHEL",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TN",
"license": "7731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.