Cleland Periodontics, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN012684 Issued in GA

Legal business name

CLELAND PERIODONTICS, PC

Practice address

1605 Highway 34 E Ste a
Newnan, GA 30265-2156

Phone

(678) 423-5000

Fax

(678) 423-5005

NPI assigned

Apr 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gordon Cleland Fraser Jr., DMD

Title

Periodontics

Phone

(678) 423-5000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225255573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 HIGHWAY 34 E STE A",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652156",
            "telephone_number": "678-423-5000",
            "fax_number": "678-423-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 HIGHWAY 34 E STE A",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652156",
            "telephone_number": "678-423-5000",
            "fax_number": "678-423-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLELAND PERIODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "CLELAND",
        "authorized_official_title_or_position": "PERIODONTICS",
        "authorized_official_telephone_number": "678-423-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "DN012684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Newnan, GA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.