Gordon Highway Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015152 Issued in GA

Legal business name

GORDON HIGHWAY DENTAL GROUP, LLC

Doing business as

Augusta Smiles Youth Dentistry

Practice address

1631 Gordon Hwy
Augusta, GA 30906

Phone

(706) 790-9302

Fax

(706) 790-9303

NPI assigned

Oct 12, 2016

Organization subpart

No

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

Authorized official

Name

Linda Susan Zoeller

Title

Authorized Official

Phone

(615) 988-2627

Specialties & licenses 1

Addresses

Other names 1

• Augusta Smiles Youth Dentistry Doing business as

Locations

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530748800000",
    "number": "1215487467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CHURCH ST STE 2210",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192204",
            "telephone_number": "615-988-2627",
            "fax_number": "631-857-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 GORDON HWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30906",
            "telephone_number": "706-790-9302",
            "fax_number": "706-790-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON HIGHWAY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2018-07-05",
        "status": "A",
        "authorized_official_last_name": "ZOELLER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-988-2627"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Augusta Smiles Youth Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Augusta Smiles Youth Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cambre Goodlett, PHARMD
• Mary Goodwin
• Richard H. Goodwin Jr., M.D.
• Mary Jo Goolsby, NP
• Keerthana Gopichandran
• Chawnette Washington Gordon, CLC
• Jamie Gordon, LPC
• Mackenzie Gordon, CTRS
• Megan Tucker Gordon, OTR/L
• Mona Gordon

• General Practice Dentistry in Augusta, GA
• Providers in Augusta, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; 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.