Active NPI
Anne Deatrick
- General Practice Dentistry
- Decatur, GA
National Provider Identifier
1437726650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN122293
- Practice address
- 144 S Columbia Dr
Decatur, GA 30030-4103 - Phone
- (404) 328-7171
- NPI assigned
- Jun 7, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN122293 | GA | Primary |
Addresses
Primary practice location
144 S Columbia Dr
Decatur, GA 30030-4103
Mailing address
7803 Amber Glen CT
Louisville, KY 40220-1578
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 |
|---|---|---|---|
| DN122293 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623024000000",
"number": "1437726650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7803 AMBER GLEN CT",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402201578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 S COLUMBIA DR",
"city": "DECATUR",
"state": "GA",
"postal_code": "300304103",
"telephone_number": "404-328-7171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATRICK",
"first_name": "ANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-07",
"last_updated": "2021-06-07",
"certification_date": "2021-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN122293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.