NPIMap

Organization Active NPI

East Atlanta Endodontics & Microsurgery, PC

  • Endodontics
  • Conyers, GA
National Provider Identifier
1437444510
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DN013277 Issued in GA
Legal business name
EAST ATLANTA ENDODONTICS & MICROSURGERY, PC
Practice address
976 E Freeway Dr SE
Suite a
Conyers, GA 30094-5965
Phone
(770) 483-1331
Fax
(770) 483-2092
NPI assigned
Jun 16, 2011
Last updated
Jun 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

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

Authorized official

Name
Dr. Jelani T Washington, DDS
Title
Owner/Dentist
Phone
(770) 483-1331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X DN013277 GA Primary

Addresses

Primary practice location

976 E Freeway Dr SE
Suite a
Conyers, GA 30094-5965

Mailing address

976 E Freeway Dr SE
Suite a
Conyers, GA 30094-5965
Phone (770) 483-1331

Other identifiers 1

IdentifierTypeStateIssuer
1083698757OtherGANPPES

National Provider Directory

National Provider Directory

Locations

976 E Freeway Dr SE
#A
Conyers, GA 30094
Phone (615) 491-2127

NPI Registry JSON

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1437444510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "976 E FREEWAY DR SE",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945965",
            "telephone_number": "770-483-1331",
            "fax_number": "770-483-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "976 E FREEWAY DR SE",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945965",
            "telephone_number": "770-483-1331",
            "fax_number": "770-483-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ATLANTA ENDODONTICS & MICROSURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "JELANI",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "770-483-1331",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "DN013277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1083698757",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; 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.