Active NPI
Stephanie Kim
- General Practice Dentistry
- Marietta, GA
National Provider Identifier
1255823175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN015647
- Practice address
- 4250 Roswell Rd Ste 110
Marietta, GA 30062-8114 - Phone
- (770) 509-5585
- NPI assigned
- Jun 6, 2018
- Last updated
- Jun 6, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN015647 | GA | Primary |
Addresses
Primary practice location
4250 Roswell Rd Ste 110
Marietta, GA 30062-8114
Mailing address
3097 Maple Dr NE Apt 544
Atlanta, GA 30305-3056
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
| License | State | Type | Specialty |
|---|---|---|---|
| DN015647 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Johnson Ferry Dentistry, PC | Past | Accepting new patients |
Organizations & group practices 1
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": "1528243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528243200000",
"number": "1255823175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3097 MAPLE DR NE APT 544",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303053056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4250 ROSWELL RD STE 110",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300628114",
"telephone_number": "770-509-5585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-06",
"last_updated": "2018-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN015647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.