Quitman Family Dentistry LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN012932 Issued in GA

Legal business name

QUITMAN FAMILY DENTISTRY LLC

Practice address

1306 E. Screven Street
Quitman, GA 31634

Phone

(229) 263-8700

NPI assigned

Aug 7, 2012

Last updated

Aug 7, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Larry M Black Jr., DMDNPI 1164558359

Title

Owner

Phone

(229) 263-8700

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Larry Milton Black Jr., DMD

  • General Practice Dentistry
  • Quitman, GA
  • NPI 1164558359
  NPD (past) Authorized official

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344297600000",
    "number": "1639426836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 E. SCREVEN STREET",
            "city": "QUITMAN",
            "state": "GA",
            "postal_code": "31634",
            "telephone_number": "229-263-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 E. SCREVEN STREET",
            "city": "QUITMAN",
            "state": "GA",
            "postal_code": "31634",
            "telephone_number": "229-263-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUITMAN FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2012-08-07",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-263-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DNSC000233",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN012932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003124373A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Presbyterian Home Pharmacy Inc (Presbyterian Home Pharmacy)
• Presbyterian Home, Quitman, Inc. (Presbyterian Home, Inc.)
• Presbyterian Hospice and Palliative Care Center, Inc..
• Primary Care of Southwest Georgia, Inc. (Primary Care of Southwest Georgia- Quitman)
• Priority Wellness
• R J Rowe OD PC
• Felicia Cora Ratliff, MS
• Regional Emergency Medical Services
• Sara Ann Rich, CCC-SLP
• Jennifer Denise Robinson, AGNP-C

• Dental Clinic/Center in Quitman, GA
• Providers in Quitman, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; 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.