NPIMap

Organization Active NPI

Mitchell Bridge Dental Association

  • Dentist
  • Athens, GA
National Provider Identifier
1609913508
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN010077 Issued in GA
Legal business name
MITCHELL BRIDGE DENTAL ASSOCIATION
Practice address
1171A Mitchell Bridge Rd
Athens, GA 30606-6411
Phone
(706) 548-2651
Fax
(706) 543-1052
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Melody J Higginbotham, DMDNPI 1710916085
Title
Dr
Phone
(706) 548-2651

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN010077 GA Primary

Addresses

Primary practice location

1171A Mitchell Bridge Rd
Athens, GA 30606-6411

Mailing address

1171A Mitchell Bridge Rd
Athens, GA 30606-6411
Phone (706) 548-2651

National Provider Directory

National Provider Directory

Locations

1171 Mitchell Bridge Rd
Ste A
Athens, GA 30606
Phone (706) 548-2651

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609913508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1171A MITCHELL BRIDGE RD",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066411",
            "telephone_number": "706-548-2651",
            "fax_number": "706-543-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1171A MITCHELL BRIDGE RD",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066411",
            "telephone_number": "706-548-2651",
            "fax_number": "706-543-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL BRIDGE DENTAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAM",
        "authorized_official_first_name": "MELODY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "706-548-2651",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN010077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.