Individual provider Active NPI

Robert Stuart Ferrill Jr., DDS

  • General Practice Dentistry
  • Roswell, GA
National Provider Identifier
1306963707
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8856 Issued in GA
Practice address
565 Colonial Park Dr
Suite 100
Roswell, GA 30075
Phone
(770) 993-6666
Fax
(770) 993-2166
NPI assigned
Mar 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8856 GA Primary

Addresses

Primary practice location

565 Colonial Park Dr
Suite 100
Roswell, GA 30075

Mailing address

565 Colonial Park Dr
Suite 100
Roswell, GA 30075
Phone (770) 993-6666

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
8856GAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306963707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 COLONIAL PARK DR",
            "address_2": "SUITE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30075",
            "telephone_number": "770-993-6666",
            "fax_number": "770-993-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 COLONIAL PARK DR",
            "address_2": "SUITE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30075",
            "telephone_number": "770-993-6666",
            "fax_number": "770-993-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERRILL",
        "first_name": "ROBERT",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "8856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

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.

Verify at the official NPI Registry.