NPIMap

Organization Active NPI

Carolina Dental Docs on-the-Go, LLC

  • Dentist
  • Kennesaw, GA
National Provider Identifier
1629444559
Registry record updated Aug 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2881 Issued in SC
Legal business name
CAROLINA DENTAL DOCS ON-THE-GO, LLC
Practice address
112 Townpark Dr NW
Suite 100
Kennesaw, GA 30144-3731
Phone
(404) 410-1340
NPI assigned
Aug 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2015

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

Authorized official

Name
Jim Nasim, DMD
Title
President
Phone
(864) 641-0495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2881 SC Primary

Addresses

Primary practice location

112 Townpark Dr NW
Suite 100
Kennesaw, GA 30144-3731

Mailing address

111 Powell Mill Rd
Spartanburg, SC 29301-1590
Phone (864) 641-0495

National Provider Directory

National Provider Directory
Tax ID family
Carolina Dental Docs - on - the - Go LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

112 Townpark Dr NW
Ste 100
Kennesaw, GA 30144
Phone (404) 410-1340

NPI Registry JSON

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

{
    "created_epoch": "1439510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439510400000",
    "number": "1629444559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 POWELL MILL RD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293011590",
            "telephone_number": "864-641-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 TOWNPARK DR NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301443731",
            "telephone_number": "404-410-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA DENTAL DOCS ON-THE-GO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-14",
        "last_updated": "2015-08-14",
        "status": "A",
        "authorized_official_last_name": "NASIM",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-641-0495",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "2881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; 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.