Alex Stephens Abernathy, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

1792-78 Issued in MS

Practice address

11 Lakeland Cir
Jackson, MS 39216-5006

Phone

(601) 981-8166

Fax

(601) 362-2164

NPI assigned

May 22, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lakeland Dental Care PA

  • General Practice Dentistry
  • Jackson, MS
  • NPI 1235441353
  NPD (past) Authorized official
• Malley Dental, PLLC

  • Dentist
  • Jackson, MS
  • NPI 1750077103
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1356550396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 BRITTON RUN",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391109698",
            "telephone_number": "601-856-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 LAKELAND CIR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165006",
            "telephone_number": "601-981-8166",
            "fax_number": "601-362-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABERNATHY",
        "first_name": "ALEX",
        "middle_name": "STEPHENS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "1792-78",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "1792-78",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor L. Abbey, AUD
• Abdu Mohamed Abdallah Ahmed, MD
• Sarah Lindsey Abdeen, PA-C
• Ashraf Sami Abdo, MD
• Rania Abdo
• John Abernathy
• Sarah L Abernathy, NP
• Albert Kalil Abide III
• Charlene Similoluwa Abidun, M.D.
• Ability Home Care, LLC

• All providers in Jackson, MS
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.