Active NPI
Herman A Donatelli, DMD
- Prosthodontics
- Atlanta, GA
National Provider Identifier
1508073966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 8852
- Practice address
- 3535 Piedmont Rd NE Ste 100
Atlanta, GA 30305 - Phone
- (404) 816-9665
- Fax
- (404) 816-0950
- NPI assigned
- May 16, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 8852 | GA | Primary |
Addresses
Primary practice location
3535 Piedmont Rd NE Ste 100
Atlanta, GA 30305
Mailing address
PO Box 387
Tucker, GA 30085-0387
Phone (678) 612-3001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210202001767 | GA | Order and Referring Only - Dentist | 7618381641 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8852 | GA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534809600000",
"number": "1508073966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 387",
"city": "TUCKER",
"state": "GA",
"postal_code": "300850387",
"telephone_number": "678-612-3001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 PIEDMONT RD NE STE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30305",
"telephone_number": "404-816-9665",
"fax_number": "404-816-0950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONATELLI",
"first_name": "HERMAN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-16",
"last_updated": "2018-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, Prosthodontics",
"state": "GA",
"license": "8852",
"primary": true
}
],
"identifiers": [],
"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 Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.