Latonya F. R. Gillespie, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN014891 Issued in GA

Practice address

1910 Highway 20 SE Ste 100
Conyers, GA 30013-2074

Phone

(404) 729-5159

NPI assigned

Oct 23, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Latonya F. R. Gillespie Professional name

Medicare fee-for-service enrollment

Enrolled in FL

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.

• Southern Pearl Dentistry

  • Dentist
  • Hampton, GA
  • NPI 1942868450
  NPD (past) Authorized official

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1376948182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SHORELINE DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302154665",
            "telephone_number": "404-729-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 HIGHWAY 20 SE STE 100",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132074",
            "telephone_number": "404-729-5159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4519 Woodruff Rd #10",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "31904",
            "country_code": "US",
            "telephone_number": "377-270-6405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLESPIE",
        "first_name": "LATONYA",
        "middle_name": "F. R.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-23",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014891",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LATONYA",
            "last_name": "GILLESPIE",
            "middle_name": "F. R.",
            "prefix": "MS.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Melissa Taylor Gibson, RPH
• Tiffany Gibson, PHARM.D.
• Gifting Wellness LLC
• Robin Lee Giles
• Abigail Gilgeous, PT
• Tamara Gilliam
• Manon M Girard, SLP
• Chandra Girdhari, CRNA
• Rodney L Givens, DDS
• Rena M Glass-Dixon, PHD, LCSW

• General Practice Dentistry in Conyers, GA
• Providers in Conyers, 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 May 30, 2019; 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.