Individual provider Active NPI

Jimmy W. Arnold, D.M.D.

  • Endodontics
  • Macon, GA
National Provider Identifier
1194136929
Registry record updated May 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
011189 Issued in GA
Practice address
152 N Crest Blvd Ste a
Macon, GA 31210-1847
Phone
(478) 757-9620
NPI assigned
May 14, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 011189 GA Primary

Addresses

Primary practice location

152 N Crest Blvd Ste a
Macon, GA 31210-1847

Mailing address

152 N Crest Blvd Ste a
Macon, GA 31210-1847
Phone (478) 757-9620

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160412001167 GA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 5597063305

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011189GAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Jimmy W Arnold, DMD Endodontics 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.

NPI Registry JSON

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400025600000",
    "number": "1194136929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 N CREST BLVD STE A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312101847",
            "telephone_number": "478-757-9620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 N CREST BLVD STE A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312101847",
            "telephone_number": "478-757-9620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARNOLD",
        "first_name": "JIMMY",
        "middle_name": "W.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "011189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.