Victor I Etheridge, DMD,PC
Individual provider Active NPI General Practice Dentistry · Sandersville, GA
NPI 1386712271 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1386712271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 8267 (GA)
- Practice address
- 524 Sparta Rd
Sandersville, GA 31082-1376 - Phone
- (478) 552-6914
- Fax
- (478) 552-8880
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160616001118 | GA | Order and Referring Only - Dentist |
9234420530 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8267 | GA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8267 | GA | Yes |
Addresses
Primary practice location
524 Sparta Rd
Sandersville, GA 31082-1376
Mailing address
524 Sparta Rd
Sandersville, GA 31082-1376
Phone (478) 552-6914
Other providers in Sandersville, GA
- John W Dickey
- Phillip Douglas
- E Chandler McDavid
- Linus Onyemaechi Ejim
- Emerald Emt, LLC.
- Michelle Prince Evans
- Constance Danielle Francis
- Ronald P. Freeman
- Kara Emily Frost
- Chadwick William Gaddis
All providers in Sandersville, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.