Mid America Group of Georgia PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MID AMERICA GROUP OF GEORGIA PC

Practice address

160 Clairemont Ave
Ste 200
Decatur, GA 30030-2546

Phone

(317) 886-6637

Fax

(888) 547-0377

NPI assigned

Apr 19, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Jewel Bernadette Smith, DDS

Title

Owner

Phone

(317) 886-6639

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1306280458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 WINDHORST WAY",
            "address_2": "STE 100",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461438800",
            "telephone_number": "317-886-6639",
            "fax_number": "888-547-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 CLAIREMONT AVE",
            "address_2": "STE 200",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302546",
            "telephone_number": "317-886-6637",
            "fax_number": "888-547-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA GROUP OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-19",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JEWEL",
        "authorized_official_middle_name": "BERNADETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-886-6639",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Decatur, GA
• Providers in Decatur, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.