Individual provider Active NPI

Christopher Hugh Kragor, MD DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
National Provider Identifier
1194082321
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN014691 Issued in GA
Practice address
1000 Johnson Ferry Rd BLDG H
Marietta, GA 30068
Phone
(770) 977-0364
Fax
(678) 483-8487
NPI assigned
Apr 12, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN014691 GA Primary

Addresses

Primary practice location

1000 Johnson Ferry Rd BLDG H
Marietta, GA 30068

Mailing address

1000 Johnson Ferry Rd BLDG H
Marietta, GA 30068-5518
Phone (770) 977-0364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180925000002 GA Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 9032420989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial SurgeryAlso: Oral Surgery
Education
Georgia Regents University College of Dental Medicine, 2012
Medicare assignment
May accept Medicare assignment
Group practices
Atlanta Oral and Facial Surgery LLCGroup PAC ID 8628062387, 24 clinicians

Practice addresses (Care Compare)

1000 Johnson Ferry Rd
Building H
Marietta, GA 30068-2100
Phone (770) 977-0364

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanta Oral & Facial Surgery LLC Oral and Maxillofacial Surgery CurrentSince Sep 1, 2018 Accepting new patients

Locations

117 Professional Ct SE
Calhoun, GA 30701
Phone (706) 629-5200

201 Oakside Ln
Ste B
Canton, GA 30114

1000 Johnson Ferry Rd
Bldg H
Marietta, GA 30068
Phone (770) 973-4344

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.

NPI Registry JSON

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

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1194082321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD BLDG H",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300685518",
            "telephone_number": "770-977-0364",
            "fax_number": "678-483-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD BLDG H",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30068",
            "telephone_number": "770-977-0364",
            "fax_number": "678-483-8487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAGOR",
        "first_name": "CHRISTOPHER",
        "middle_name": "HUGH",
        "name_prefix": "Dr.",
        "credential": "MD DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-12",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN014691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.