NPIMap

Organization Active NPI

Bobby R Childree DMD PC

  • Dentist
  • Jasper, GA
National Provider Identifier
1235247644
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8754 Issued in GA
Legal business name
BOBBY R CHILDREE DMD PC
Practice address
175 South Main Street
Jasper, GA 30143
Phone
(706) 692-2646
Fax
(706) 253-3202
NPI assigned
Aug 26, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Bobby Ray Childree, DMD
Title
President of Corporation (PC)
Phone
(706) 692-2646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8754 GA Primary

Addresses

Primary practice location

175 South Main Street
Jasper, GA 30143

Mailing address

175 South Main Street
PO Box 698
Jasper, GA 30143
Phone (706) 692-2646

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235247644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 SOUTH MAIN STREET",
            "address_2": "PO BOX 698",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "30143",
            "telephone_number": "706-692-2646",
            "fax_number": "706-253-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 SOUTH MAIN STREET",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "30143",
            "telephone_number": "706-692-2646",
            "fax_number": "706-253-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOBBY R CHILDREE DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHILDREE",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION (PC)",
        "authorized_official_telephone_number": "706-692-2646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "8754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, GA

Sources for this page

  • 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.