Active NPI
Michael Donald Marable, DMD
- General Practice Dentistry
- Moultrie, GA
National Provider Identifier
1346366648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10909
- Practice address
- 307 5TH St SE
Moultrie, GA 31768-4838 - Phone
- (229) 985-5092
- Fax
- (229) 985-0138
- NPI assigned
- Mar 21, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10909 | GA | Primary |
Addresses
Primary practice location
307 5TH St SE
Moultrie, GA 31768-4838
Mailing address
307 5TH St SE
Moultrie, GA 31768-4838
Phone (229) 985-5092
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10909 | Other | GA | DENTIST LICENSE NUMBER |
| 000431527A | Medicaid | GA |
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 |
|---|---|---|---|
| 10909 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomasville Dental Associates | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Moultrie, GA
- NPI 1841550720
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445385600000",
"number": "1346366648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 5TH ST SE",
"city": "MOULTRIE",
"state": "GA",
"postal_code": "317684838",
"telephone_number": "229-985-5092",
"fax_number": "229-985-0138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 5TH ST SE",
"city": "MOULTRIE",
"state": "GA",
"postal_code": "317684838",
"telephone_number": "229-985-5092",
"fax_number": "229-985-0138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARABLE",
"first_name": "MICHAEL",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2015-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "10909",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTIST LICENSE NUMBER",
"identifier": "10909",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000431527A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moultrie, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.