Active NPI
Kenneth Hortman
- Denturist
- Roberta, GA
National Provider Identifier
1619329307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- Practice address
- 143 E Crusselle St
Roberta, GA 31078-4866 - Phone
- (478) 836-2994
- NPI assigned
- Jul 6, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Denturist | 122400000X | Primary |
Addresses
Primary practice location
143 E Crusselle St
Roberta, GA 31078-4866
Mailing address
PO Box 900
Roberta, GA 31078-0900
Phone (478) 836-2994
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467763200000",
"number": "1619329307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 900",
"city": "ROBERTA",
"state": "GA",
"postal_code": "310780900",
"telephone_number": "478-836-2994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "143 E CRUSSELLE ST",
"city": "ROBERTA",
"state": "GA",
"postal_code": "310784866",
"telephone_number": "478-836-2994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HORTMAN",
"first_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-06",
"last_updated": "2016-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roberta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.