NPIMap

Organization Active NPI

Jeffrey K Waters D.M.D., P.C

  • Endodontics
  • Decatur, GA
National Provider Identifier
1396933792
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DN013125 Issued in GA
Legal business name
JEFFREY K WATERS D.M.D., P.C
Practice address
2680 Lawrenceville Hwy
Suite 102
Decatur, GA 30033-2500
Phone
(678) 990-8034
Fax
(770) 934-7176
NPI assigned
Oct 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Authorized official

Name
Dr. Jeffrey Kent Waters, D.M.D., M.S.NPI 1245404714
Title
Owner
Phone
(678) 990-8034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X DN013125 GA Primary

Addresses

Primary practice location

2680 Lawrenceville Hwy
Suite 102
Decatur, GA 30033-2500

Mailing address

2680 Lawrenceville Hwy
Suite 102
Decatur, GA 30033-2526
Phone (678) 990-8034

Other names 1

  • Endodontics of Atlanta Other name

National Provider Directory

National Provider Directory

Locations

2680 Lawrenceville Hwy
Ste 102
Decatur, GA 30033
Phone (678) 990-8034

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347494400000",
    "number": "1396933792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 LAWRENCEVILLE HWY",
            "address_2": "SUITE 102",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300332526",
            "telephone_number": "678-990-8034",
            "fax_number": "770-934-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 LAWRENCEVILLE HWY",
            "address_2": "SUITE 102",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300332500",
            "telephone_number": "678-990-8034",
            "fax_number": "770-934-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY K WATERS D.M.D., P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2012-09-13",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-990-8034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "DN013125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endodontics of Atlanta",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.