NPIMap

Individual provider Active NPI

Noelan Schafer

  • General Practice Dentistry
  • Kodak, TN
National Provider Identifier
1245779701
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10572 Issued in TN
Practice address
2946 Winfield Dunn Pkwy Ste 301
Kodak, TN 37764-4319
Phone
(865) 465-7058
NPI assigned
Feb 16, 2017
Last updated
Oct 26, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN015714 GA
General Practice Dentistry 1223G0001X 10572 TN Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

2946 Winfield Dunn Pkwy Ste 301
Kodak, TN 37764-4319

Mailing address

4795 Sugarloaf Parkway
Buford, GA 30519
Phone (470) 223-3532

Other practice location 1

875 Union Ave
Memphis, TN 38103-3513
Phone (901) 448-2242

Other practice location 2

4795 Sugarloaf parkway
Buford, GA 30519
Phone (470) 223-3532

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN015714GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kodak Family Dental, PLLC CurrentSince Nov 1, 2020 Accepting new patients
Eugene Stinson DDS General Practice PastSince Nov 1, 2020 Accepting new patients

Locations

2946 Winfield Dunn Pkwy
Ste 301
Kodak, TN 37764
Phone (865) 465-7058

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1487203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1245779701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4795 SUGARLOAF PARKWAY",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30519",
            "telephone_number": "470-223-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2946 WINFIELD DUNN PKWY STE 301",
            "city": "KODAK",
            "state": "TN",
            "postal_code": "377644319",
            "telephone_number": "865-465-7058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "875 Union Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033513",
            "country_code": "US",
            "telephone_number": "901-448-2242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4795 Sugarloaf parkway",
            "address_purpose": "LOCATION",
            "city": "Buford",
            "state": "GA",
            "postal_code": "30519",
            "country_code": "US",
            "telephone_number": "470-223-3532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHAFER",
        "first_name": "NOELAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-16",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015714",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "10572",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kodak, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.