John David Roan, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN008219 Issued in GA

Practice address

2720 N Oak St
Valdosta, GA 31602-1781

Phone

(229) 247-5590

Fax

(229) 241-0698

NPI assigned

Jun 16, 2005

Reactivated

Mar 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• SGMC Physician Network Inc

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1417597170
  NPD (past)
• Valdosta Oral and Maxillofacial Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Valdosta, GA
  • NPI 1912173022
  NPD (past)

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1508861428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021781",
            "telephone_number": "229-247-5590",
            "fax_number": "229-241-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021781",
            "telephone_number": "229-247-5590",
            "fax_number": "229-241-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROAN",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2026-07-13",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN008219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley Gene Ridge, P.A.-C
• Right Fit Therapy & Counselling
• Jamie Teresa Riley, FNP-C
• Sara E. Riley, MSCP, LPC, NCC
• Wilfredo Rios, MD
• Robert Robe, CRNA
• Cristina Roberson Perez
• Nathan Kelly Roberson, NP-C
• Alisha Lashay Roberts
• Andrael Chantal Roberts

• Oral and Maxillofacial Surgery (Dentist) in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.