Austin Jeffrey Secrist, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN122717 Issued in GA

Practice address

115 Gordon St
Thomson, GA 30824-1537

Phone

(760) 221-5892

NPI assigned

Jun 25, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Austin Secrist DMD LLC

  • Dental Clinic/Center
  • Thomson, GA
  • NPI 1740992551
  NPD Authorized official

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

{
    "created_epoch": "1656115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656115200000",
    "number": "1346972791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 TURNER DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308096704",
            "telephone_number": "760-221-5892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GORDON ST",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "308241537",
            "telephone_number": "760-221-5892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SECRIST",
        "first_name": "AUSTIN",
        "middle_name": "JEFFREY",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-25",
        "last_updated": "2022-06-25",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN122717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rosalind Felecia Scott, LPC
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• Tracey Shaffer, PA
• James Christopher Sheppard, MD
• Karen Lee Shouse, APRN-BC
• Laura W. Smith, RN
• Southern Home Care Services, Inc.

• General Practice Dentistry in Thomson, GA
• Providers in Thomson, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2022; 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.