One Smile Away Inc

Primary specialty

DentistTaxonomy code 122300000X

License

DN017325 Issued in GA

Legal business name

ONE SMILE AWAY INC

Practice address

4159 Elders Dr
Augusta, GA 30909-9145

Phone

(706) 231-0170

NPI assigned

Sep 19, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Tyjuan Marcquell Williams, DMD

Title

Owner

Phone

(706) 231-0170

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1558797761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 JIMMIE DYESS PKWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099491",
            "telephone_number": "706-231-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4159 ELDERS DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099145",
            "telephone_number": "706-231-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE SMILE AWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "TYJUAN",
        "authorized_official_middle_name": "MARCQUELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-231-0170",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN017325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003107901A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; 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.