Emily Caroline Medendorp, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN123920 Issued in GA

Practice address

330 Corporate Center CT
Stockbridge, GA 30281-6360

Phone

(770) 901-2492

NPI assigned

Aug 11, 2025

Sex

Female

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1609751346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2344 HAVENRIDGE DR NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303054073",
            "telephone_number": "404-606-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 CORPORATE CENTER CT",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816360",
            "telephone_number": "770-901-2492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDENDORP",
        "first_name": "EMILY",
        "middle_name": "CAROLINE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-11",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN123920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Anne McQueen, PMHNP
• Desha McWilliams
• Ryan Meacham, PA-AA
• Med Path Professional Services, Inc.
• Med-South Primary Care
• Medex of Georgia Inc
• Medical Escort LLC
• Medicine Pointe Pharmacy LLC
• Miles Anthony Medina, D.O.
• Medsure Supplies LLC

• General Practice Dentistry in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.