Individual provider Active NPI

Robin Dwayne Ashford, D.D.S.

  • Dentist
  • Fayetteville, GA
National Provider Identifier
1336206655
Registry record updated Jan 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9996 Issued in GA
Practice address
101 Beckett LN
Suite 404
Fayetteville, GA 30214-7159
Phone
(770) 461-0400
Fax
(770) 461-0280
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9996 GA Primary

Addresses

Primary practice location

101 Beckett LN
Suite 404
Fayetteville, GA 30214-7159

Mailing address

101 Beckett LN
Ste 404
Fayetteville, GA 30214-7159
Phone (770) 461-0400

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
9996GAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454025600000",
    "number": "1336206655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BECKETT LN",
            "address_2": "STE 404",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147159",
            "telephone_number": "770-461-0400",
            "fax_number": "770-461-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BECKETT LN",
            "address_2": "SUITE 404",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147159",
            "telephone_number": "770-461-0400",
            "fax_number": "770-461-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASHFORD",
        "first_name": "ROBIN",
        "middle_name": "DWAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2016-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "9996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; 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.