Jevae Leniece Nelson, DDS, DMSC

Primary specialty

DentistTaxonomy code 122300000X

License

DN122573 Issued in GA

Practice address

4070 Lavista Rd Unit 102
Tucker, GA 30084-5228

Phone

(770) 515-8532

NPI assigned

May 8, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1225527914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2554 SIBLEY DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303243104",
            "telephone_number": "816-304-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 LAVISTA RD UNIT 102",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845228",
            "telephone_number": "770-515-8532"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Dimock St",
            "address_purpose": "LOCATION",
            "city": "Roxbury",
            "state": "MA",
            "postal_code": "021191029",
            "country_code": "US",
            "telephone_number": "161-744-2880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JEVAE",
        "middle_name": "LENIECE",
        "name_prefix": "Dr.",
        "credential": "DDS, DMSC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-08",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122573",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1857897",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Tucker, GA
• Providers in Tucker, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.