Active NPI
Grayson York
- Dentist
- Ellijay, GA
National Provider Identifier
1336939628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN123859
- Practice address
- 21 Westbrook Blvd
Ellijay, GA 30536 - Phone
- (706) 635-2218
- NPI assigned
- May 9, 2025
- Sex
- Male
- 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 | DN123859 | GA | Primary |
Addresses
Primary practice location
21 Westbrook Blvd
Ellijay, GA 30536
Mailing address
448 Central Way
Chatsworth, GA 30705-7327
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 |
|---|---|---|---|
| DN123859 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753315200000",
"number": "1336939628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "448 CENTRAL WAY",
"city": "CHATSWORTH",
"state": "GA",
"postal_code": "307057327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 WESTBROOK BLVD",
"city": "ELLIJAY",
"state": "GA",
"postal_code": "30536",
"telephone_number": "706-635-2218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YORK",
"first_name": "GRAYSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-09",
"last_updated": "2025-07-24",
"certification_date": "2025-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN123859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellijay, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.