Individual provider Active NPI

Richard A Meaders, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
National Provider Identifier
1396749958
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN0011162 Issued in GA
Practice address
1000 Johnson Ferry Rd
BLDG H
Marietta, GA 30068-5518
Phone
(770) 977-0364
Fax
(678) 819-6531
NPI assigned
Jun 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN0011162 GA Primary

Addresses

Primary practice location

1000 Johnson Ferry Rd
BLDG H
Marietta, GA 30068-5518

Mailing address

1000 Johnson Ferry Rd
BLDG H
Marietta, GA 30068-5518
Phone (770) 977-0364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101213000900 GA Practitioner - Maxillofacial Surgery 2062609365 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN0011162GAMDOral and Maxillofacial Surgery (Dentist)
11162GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanta Oral & Facial Surgery LLC Oral and Maxillofacial Surgery CurrentSince Jan 1, 2002 Accepting new patients

Locations

1505 Northside Blvd
Ste 2700
Cumming, GA 30041
Phone (770) 844-7894

1121 Johnson Ferry Rd
Ste 400
Marietta, GA 30068
Phone (404) 973-4344

1000 Johnson Ferry Rd
Bldg H
Marietta, GA 30068
Phone (770) 973-4344

3895 Johns Creek Pkwy
Ste C
Suwanee, GA 30024
Phone (770) 418-0440

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282262400000",
    "number": "1396749958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD",
            "address_2": "BLDG H",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300685518",
            "telephone_number": "770-977-0364",
            "fax_number": "678-819-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD",
            "address_2": "BLDG H",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300685518",
            "telephone_number": "770-977-0364",
            "fax_number": "678-819-6531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEADERS",
        "first_name": "RICHARD",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2010-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN0011162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.