Active NPI
Amy D Russell, DMD
- Dentist
- Dunwoody, GA
National Provider Identifier
1265634638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DNO12813
- Practice address
- 1651 Mount Vernon Rd
Dunwoody, GA 30338-4264 - Phone
- (770) 394-3920
- Fax
- (770) 393-0741
- NPI assigned
- Jun 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | DNO12813 | GA | Primary |
Addresses
Primary practice location
1651 Mount Vernon Rd
Dunwoody, GA 30338-4264
Mailing address
1651 Mount Vernon Rd
Dunwoody, GA 30338-4264
Phone (770) 394-3920
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 |
|---|---|---|---|
| DNO12813 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333584000000",
"number": "1265634638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1651 MOUNT VERNON RD",
"city": "DUNWOODY",
"state": "GA",
"postal_code": "303384264",
"telephone_number": "770-394-3920",
"fax_number": "770-393-0741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1651 MOUNT VERNON RD",
"city": "DUNWOODY",
"state": "GA",
"postal_code": "303384264",
"telephone_number": "770-394-3920",
"fax_number": "770-393-0741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "AMY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-05",
"last_updated": "2012-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DNO12813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dunwoody, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.