NPIMap

Organization Active NPI

Bennett & Maxwell Family Dentistry

  • Dentist
  • Valdosta, GA
National Provider Identifier
1417108366
Registry record updated Oct 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11562 Issued in GA
Legal business name
BENNETT & MAXWELL FAMILY DENTISTRY
Practice address
2415 Andover Dr
Valdosta, GA 31602-1280
Phone
(229) 671-1900
Fax
(229) 671-1999
NPI assigned
Oct 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2008

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

Authorized official

Name
Dr. Douglas Courtney Maxwell, DMDNPI 1205999133
Title
Owner
Phone
(229) 671-1900

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 11562 GA Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 11534 GA

Addresses

Primary practice location

2415 Andover Dr
Valdosta, GA 31602-1280

Mailing address

2415 Andover Dr
Valdosta, GA 31602-1280
Phone (229) 671-1900

Other identifiers 2

IdentifierTypeStateIssuer
000961276AMedicaidGA
000963256AMedicaidGA

National Provider Directory

National Provider Directory

Locations

2415 Andover Dr
Valdosta, GA 31602
Phone (229) 671-1900

Practitioners 1

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": "1223424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223424000000",
    "number": "1417108366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 ANDOVER DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021280",
            "telephone_number": "229-671-1900",
            "fax_number": "229-671-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 ANDOVER DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021280",
            "telephone_number": "229-671-1900",
            "fax_number": "229-671-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT & MAXWELL FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-08",
        "last_updated": "2008-10-08",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "COURTNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-671-1900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "11562",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "11534",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000961276A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000963256A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; 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.