Active NPI
Chad Andrew Till, DMD
- Dentist
- Jersey, GA
National Provider Identifier
1407427776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN122581
- Practice address
- 129 Main Street
Jersey, GA 30018 - Phone
- (770) 464-3626
- NPI assigned
- Jul 7, 2021
- Last updated
- May 25, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN122581 | GA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
129 Main Street
Jersey, GA 30018
Mailing address
PO Box 275
Jersey, GA 30018-0275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN122581 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653436800000",
"number": "1407427776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 275",
"city": "JERSEY",
"state": "GA",
"postal_code": "300180275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 MAIN STREET",
"city": "JERSEY",
"state": "GA",
"postal_code": "30018",
"telephone_number": "770-464-3626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILL",
"first_name": "CHAD",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-07",
"last_updated": "2022-05-25",
"certification_date": "2022-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN122581",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.