Individual provider Active NPI

Robert Pauley Jr., DMD

  • General Practice Dentistry
  • Union City, GA
National Provider Identifier
1346311479
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN010732 Issued in GA
Practice address
4651 Flat Shoals Rd
Union City, GA 30291-1573
Phone
(770) 964-1469
Fax
(770) 964-2105
NPI assigned
Nov 12, 2006
Sex
Male
Sole proprietor
Yes

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8906 CO
General Practice Dentistry 1223G0001X DN010732 GA Primary

Addresses

Primary practice location

4651 Flat Shoals Rd
Union City, GA 30291-1573

Mailing address

4651 Flat Shoals Rd
Union City, GA 30291-1573
Phone (770) 964-1469

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
I20160420002070 GA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1658679865

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN010732GAMDGeneral Practice Dentistry
8906COMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1163289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346311479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 FLAT SHOALS RD",
            "city": "UNION CITY",
            "state": "GA",
            "postal_code": "302911573",
            "telephone_number": "770-964-1469",
            "fax_number": "770-964-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 FLAT SHOALS RD",
            "city": "UNION CITY",
            "state": "GA",
            "postal_code": "302911573",
            "telephone_number": "770-964-1469",
            "fax_number": "770-964-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULEY",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8906",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN010732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union City, GA

Sources for this page

Verify at the official NPI Registry.