Active NPI
Jill E McEachin, DMD
- General Practice Dentistry
- Tifton, GA
National Provider Identifier
1508935677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DNO11764
- Practice address
- 1499 Kennedy Rd Ste a
Tifton, GA 31794-4177 - Phone
- (229) 382-0467
- Fax
- (229) 382-8714
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- No
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 | DNO11764 | GA | Primary |
Addresses
Primary practice location
1499 Kennedy Rd Ste a
Tifton, GA 31794-4177
Mailing address
PO Box 1295
Tifton, GA 31793-1295
Phone (229) 382-0467
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 724756 | Other | GA | UNITED CONCORDIA |
| 9184128 | Medicaid | GA | |
| 00923469 | Medicaid | GA | |
| 910233 | Other | GA | BCBS |
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 |
|---|---|---|---|
| DNO11764 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tift Regional Dental Group, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Tifton, GA
- NPI 1851460075
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1508935677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1295",
"city": "TIFTON",
"state": "GA",
"postal_code": "317931295",
"telephone_number": "229-382-0467",
"fax_number": "229-382-8714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1499 KENNEDY RD STE A",
"city": "TIFTON",
"state": "GA",
"postal_code": "317944177",
"telephone_number": "229-382-0467",
"fax_number": "229-382-8714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCEACHIN",
"first_name": "JILL",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DNO11764",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "724756",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9184128",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00923469",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "910233",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tifton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.