Individual provider Active NPI

Richard W Putnam, DDS

  • General Practice Dentistry
  • Blairsville, GA
National Provider Identifier
1205938032
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7788 Issued in GA
Practice address
395 Cleveland St
Suite 1
Blairsville, GA 30512
Phone
(706) 745-6848
NPI assigned
Sep 2, 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 7788 GA Primary

Addresses

Primary practice location

395 Cleveland St
Suite 1
Blairsville, GA 30512

Mailing address

PO Box 2059
Blairsville, GA 30514
Phone (706) 745-6848

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
I20151027001063 GA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7810206125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7788GAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205938032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2059",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "30514",
            "telephone_number": "706-745-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 CLEVELAND ST",
            "address_2": "SUITE 1",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "30512",
            "telephone_number": "706-745-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTNAM",
        "first_name": "RICHARD",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "7788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blairsville, GA

Sources for this page

Verify at the official NPI Registry.