South Georgia Periodontics, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

SOUTH GEORGIA PERIODONTICS, PC

Practice address

307 Georgetown Cir
Valdosta, GA 31602-4113

Phone

(229) 247-0437

Fax

(229) 242-4395

NPI assigned

Jul 31, 2008

Last updated

Jul 31, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brent B. Depta, DMDNPI 1649370339

Title

Owner

Phone

(229) 247-0437

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brent Depta, D.M.D.

  • Periodontics
  • Valdosta, GA
  • NPI 1649370339
  NPD (past) Authorized official

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1194981910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 GEORGETOWN CIR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316024113",
            "telephone_number": "229-247-0437",
            "fax_number": "229-242-4395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 GEORGETOWN CIR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316024113",
            "telephone_number": "229-247-0437",
            "fax_number": "229-242-4395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA PERIODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-31",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "DEPTA",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-247-0437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• South Georgia Pediatric and Allergy Center
• South Georgia Psychiatric & Counseling Center
• South Georgia Regional Anesthesia, PC
• South Georgia Toxicology, Inc
• South Georgia Transitional Living Center (Distinct Minds Academy)
• South Georgia Upper Cervical Chiropractic, LLC (South Georgia Upper Cervical Chiropractic)

• Periodontics in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.