Active NPI
Montina Golphin Jackson, DMD
- General Practice Dentistry
- Atlanta, GA
National Provider Identifier
1497875504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DNO10785
- Practice address
- 2197 Martin Luther King Jr Dr SW
Atlanta, GA 30310-1143 - Phone
- (404) 699-1919
- Fax
- (404) 699-1402
- NPI assigned
- Mar 30, 2007
- 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 | DNO10785 | GA | Primary |
Addresses
Primary practice location
2197 Martin Luther King Jr Dr SW
Atlanta, GA 30310-1143
Mailing address
2197 Martin Luther King Jr Dr SW
Atlanta, GA 30310-1143
Phone (404) 699-1919
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00443968A | Medicaid | GA |
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 |
|---|---|---|---|
| DNO10785 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497875504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2197 MARTIN LUTHER KING JR DR SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303101143",
"telephone_number": "404-699-1919",
"fax_number": "404-699-1402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2197 MARTIN LUTHER KING JR DR SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303101143",
"telephone_number": "404-699-1919",
"fax_number": "404-699-1402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MONTINA",
"middle_name": "GOLPHIN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DNO10785",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00443968A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.