Oral an Implant Surgery Specialists, PC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

007973 Issued in GA

Legal business name

ORAL AN IMPLANT SURGERY SPECIALISTS, PC

Practice address

1260 Highway 54 W
Suite 200
Fayetteville, GA 30214-4514

Phone

(770) 461-2101

Fax

(770) 460-1292

NPI assigned

Sep 10, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Durwood M Johnson Jr., DMDNPI 1861505141

Title

Doctor

Phone

(770) 461-2101

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Durwood M Johnson Jr., DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Fayetteville, GA
  • NPI 1861505141
  Authorized official Same address or phone

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368144000000",
    "number": "1396094074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 HIGHWAY 54 W",
            "address_2": "SUITE 200",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144514",
            "telephone_number": "770-461-2101",
            "fax_number": "770-460-1292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 HIGHWAY 54 W",
            "address_2": "SUITE 200",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144514",
            "telephone_number": "770-461-2101",
            "fax_number": "770-460-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AN IMPLANT SURGERY SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-10",
        "last_updated": "2013-05-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DURWOOD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "770-461-2101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "GA",
            "license": "007973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000189351B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Esohe Osaghae, MSN, RN-BC, CCM

• Oral & Maxillofacial Surgery (D.M.D.) in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; 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.