Individual provider Active NPI

Bradley T Cox, D.M.D.

  • General Practice Dentistry
  • Cleveland, GA
National Provider Identifier
1558429803
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12934 Issued in GA
Practice address
3777 Highway 129 South
Cleveland, GA 30564
Phone
(706) 219-0033
Fax
(706) 219-0048
NPI assigned
Dec 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12934 GA Primary

Addresses

Primary practice location

3777 Highway 129 South
Cleveland, GA 30564

Mailing address

3777 Highway 129 South
Cleveland, GA 30564
Phone (706) 219-0033

Other identifiers 1

IdentifierTypeStateIssuer
962922049AMedicaidGA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160112001843 GA Order and Referring Only - DentistPractitioner - Dentist 5395047047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12934GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
O.W.a. Management Services, LLC 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.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421798400000",
    "number": "1558429803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3777 HIGHWAY 129 SOUTH",
            "city": "CLEVELAND",
            "state": "GA",
            "postal_code": "30564",
            "telephone_number": "706-219-0033",
            "fax_number": "706-219-0048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3777 HIGHWAY 129 SOUTH",
            "city": "CLEVELAND",
            "state": "GA",
            "postal_code": "30564",
            "telephone_number": "706-219-0033",
            "fax_number": "706-219-0048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COX",
        "first_name": "BRADLEY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2015-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "12934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "962922049A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, GA

Sources for this page

Verify at the official NPI Registry.