Individual provider Active NPI

Michael Grant Parkerson, D.M.D.

  • General Practice Dentistry
  • Warner Robins, GA
National Provider Identifier
1336288182
Registry record updated Feb 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN013109 Issued in GA
Practice address
229 Carl Vinson Parkway
Warner Robins, GA 31088-0000
Phone
(478) 922-4922
Fax
(478) 929-5292
NPI assigned
Feb 6, 2007
Last updated
Feb 25, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2016

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 DN013109 GA Primary

Addresses

Primary practice location

229 Carl Vinson Parkway
Warner Robins, GA 31088-0000

Mailing address

229 Carl Vinson Pkwy
Warner Robins, GA 31088-5815
Phone (478) 922-4922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150810001080 GA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8325352016

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN013109GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Dental Alliance Warner Robins C Vinson Pky, LLC Past Accepting new patients
Dental Associates of Warner Robins, LLC General Practice 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.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1336288182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 CARL VINSON PKWY",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310885815",
            "telephone_number": "478-922-4922",
            "fax_number": "478-929-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 CARL VINSON PARKWAY",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310880000",
            "telephone_number": "478-922-4922",
            "fax_number": "478-929-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKERSON",
        "first_name": "MICHAEL",
        "middle_name": "GRANT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

Verify at the official NPI Registry.