Active NPI
James Randall Deatherage
- Dentist
- Brewton, AL
National Provider Identifier
1265543797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4913
- Practice address
- 422 Douglas Avenue
Brewton, AL 36426 - Phone
- (251) 867-6837
- Fax
- (251) 867-6278
- NPI assigned
- Aug 31, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4913 | AL | Primary |
Addresses
Primary practice location
422 Douglas Avenue
Brewton, AL 36426
Mailing address
422 Douglas Avenue
Brewton, AL 36426
Phone (251) 867-6837
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 |
|---|---|---|---|
| 4913 | AL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| James R. Deatherage D.M.D.,P.C. | Dentist | Past | Accepting new patients |
| Michael a. Dasinger | Past | Accepting new patients |
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.
-
- Dentist
- Brewton, AL
- NPI 1730404187
-
- General Practice Dentistry
- Brewton, AL
- NPI 1891959151
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265543797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "422 DOUGLAS AVENUE",
"city": "BREWTON",
"state": "AL",
"postal_code": "36426",
"telephone_number": "251-867-6837",
"fax_number": "251-867-6278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "422 DOUGLAS AVENUE",
"city": "BREWTON",
"state": "AL",
"postal_code": "36426",
"telephone_number": "251-867-6837",
"fax_number": "251-867-6278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATHERAGE",
"first_name": "JAMES",
"middle_name": "RANDALL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "4913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brewton, AL
- D. W. McMillan Memorial Hospital (D. W. McMillan Home Health)
- D.W. McMillan Memorial Hospital (D W McMillan Medical Center)
- D.W. McMillan Memorial Hospital / Escambia County Health Authority (D.W. McMillan Memorial Hospital / Escambia County Health Aut)
- Tolondonakia Rachelle Daniels
- Tracy Kelly Davis
- Robert Anthony Defrancisco, PHD
- Dependable Home Healthcare Services
- Dialysis Affiliates of South Alabama
- DW McMillan Memorial Hospital
- DW McMillan Memorial Hospital
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.