Active NPI
Candis Marie Callaway, DMD
- Dentist
- McDonough, GA
National Provider Identifier
1568986198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN015496
- Practice address
- 1430 Highway 20 W
McDonough, GA 30253-7305 - Phone
- (678) 537-6000
- NPI assigned
- Jul 25, 2017
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN015496 | GA | Primary |
Addresses
Primary practice location
1430 Highway 20 W
McDonough, GA 30253-7305
Mailing address
1809 Rover Zetella Rd
Williamson, GA 30292-3797
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 |
|---|---|---|---|---|
| I20170927002737 | GA | Order and Referring Only - Dentist | 0840564944 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ga Dentistry Services PC | Past | Accepting new patients | |
| Kevin D. Oh, LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 2
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": "1500940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501459200000",
"number": "1568986198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1809 ROVER ZETELLA RD",
"city": "WILLIAMSON",
"state": "GA",
"postal_code": "302923797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 HIGHWAY 20 W",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302537305",
"telephone_number": "678-537-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLAWAY",
"first_name": "CANDIS",
"middle_name": "MARIE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-25",
"last_updated": "2017-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN015496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McDonough, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; 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.