Joel Ray Tidwell, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN009481 Issued in GA

Practice address

5897 Stewart Pkwy
Douglasville, GA 30135-2373

Phone

(770) 949-1821

Fax

(770) 942-2837

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

No

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Douglas Dental Care LLC

  • General Practice Dentistry
  • Douglasville, GA
  • NPI 1982971057
  NPD

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1386790848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5897 STEWART PKWY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352373",
            "telephone_number": "770-949-1821",
            "fax_number": "770-942-2837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5897 STEWART PKWY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352373",
            "telephone_number": "770-949-1821",
            "fax_number": "770-942-2837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JOEL",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN009481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asia Thompson
• Kay E Thompson, RN
• Anuradha R Thopu, MD
• Alison M. Thornton, N.P.
• Maurica Lamonte Thrower
• Katherine Tillem, PA-C
• Timothy N. Byrd, DMD & Associates of Douglasville, PC
• TL Smith Healthcare LLC
• TMC Total Care Family Medicine Inc
• Charkeshia Toatley, LPC

• Dentist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.