Individual provider Active NPI

James Randolph Sandlin Sr., D.D.S.

  • General Practice Dentistry
  • Lawrenceville, GA
National Provider Identifier
1194759217
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
009779 Issued in GA
Practice address
1685 Duluth Hwy
Lawrenceville, GA 30043-5010
Phone
(770) 339-0101
Fax
(770) 339-0176
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 009779 GA Primary

Addresses

Primary practice location

1685 Duluth Hwy
Lawrenceville, GA 30043-5010

Mailing address

1685 Duluth Hwy
Lawrenceville, GA 30043-5010
Phone (770) 339-0101

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
I20150708001666 GA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3072825884

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009779GAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194759217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1685 DULUTH HWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435010",
            "telephone_number": "770-339-0101",
            "fax_number": "770-339-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 DULUTH HWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435010",
            "telephone_number": "770-339-0101",
            "fax_number": "770-339-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDLIN",
        "first_name": "JAMES",
        "middle_name": "RANDOLPH",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "009779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.