NPIMap

Organization Active NPI

Peachtree City Dental Group, PC

  • General Practice Dentistry
  • Peachtree City, GA
National Provider Identifier
1487030847
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PEACHTREE CITY DENTAL GROUP, PC
Practice address
1001 N Peachtree Pkwy
Suite a
Peachtree City, GA 30269-4210
Phone
(770) 268-9112
Fax
(770) 631-0023
NPI assigned
Aug 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

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

Authorized official

Name
Dr. Jelana Bryan, DDS
Title
Owner
Phone
(770) 268-9112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1001 N Peachtree Pkwy
Suite a
Peachtree City, GA 30269-4210

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • Peachtree Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

1001 N Peachtree Pkwy
Ste A
Peachtree City, GA 30269
Phone (770) 268-9112

Practitioners & affiliated clinicians

Practitioners 5

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": "1438905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1487030847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 N PEACHTREE PKWY",
            "address_2": "SUITE A",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694210",
            "telephone_number": "770-268-9112",
            "fax_number": "770-631-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE CITY DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-07",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "JELANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-268-9112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peachtree Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.

Verify at the official NPI Registry.