Active NPI
Kim Jackson Mathews, DMD
- Pediatric Dentistry
- Newnan, GA
National Provider Identifier
1639349970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12198
- Practice address
- 2401 Newnan Crossing Blvd E
Suite 210
Newnan, GA 30265-2408 - Phone
- (770) 251-5777
- NPI assigned
- Mar 3, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 12198 | GA | Primary |
Addresses
Primary practice location
2401 Newnan Crossing Blvd E
Suite 210
Newnan, GA 30265-2408
Mailing address
2401 Newnan Crossing Blvd E
Suite 210
Newnan, GA 30265-2408
Phone (770) 251-5777
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12198 | GA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Dentistry of Newnan, LLC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Newnan, GA
- NPI 1336900166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424736000000",
"number": "1639349970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 NEWNAN CROSSING BLVD E",
"address_2": "SUITE 210",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302652408",
"telephone_number": "770-251-5777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 NEWNAN CROSSING BLVD E",
"address_2": "SUITE 210",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302652408",
"telephone_number": "770-251-5777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEWS",
"first_name": "KIM",
"middle_name": "JACKSON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-03",
"last_updated": "2015-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "12198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newnan, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.