Active NPI
Jyothirmayi Mamidi
- Dentist
- Sandy Springs, GA
National Provider Identifier
1417804907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN124083
- Practice address
- 4600 Roswell Rd Unit C120
Sandy Springs, GA 30342-3189 - Phone
- (404) 341-9593
- NPI assigned
- Mar 13, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN124083 | GA | Primary |
Addresses
Primary practice location
4600 Roswell Rd Unit C120
Sandy Springs, GA 30342-3189
Mailing address
3812 Mine Creek LN
Marietta, GA 30062-5884
Phone (216) 534-6237
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN124083 | GA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chastain Park Dentistry, PC | Past | Accepting new patients |
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.
-
dba Chastain Park Dentistry
- General Practice Dentistry
- Sandy Springs, GA
- NPI 1902266638
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773360000000",
"number": "1417804907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3812 MINE CREEK LN",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300625884",
"telephone_number": "216-534-6237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 ROSWELL RD UNIT C120",
"city": "SANDY SPRINGS",
"state": "GA",
"postal_code": "303423189",
"telephone_number": "404-341-9593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMIDI",
"first_name": "JYOTHIRMAYI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-03-13",
"last_updated": "2026-03-13",
"certification_date": "2026-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN124083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandy Springs, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.