Jeremy Eric Hadibe, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN015617 Issued in GA

Practice address

1545 Powers Ferry Rd SE Ste 200
Marietta, GA 30067-9417

Phone

(709) 809-4047

NPI assigned

Jul 28, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1689839805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 POWERS FERRY RD SE STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300679417",
            "telephone_number": "770-980-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 POWERS FERRY RD SE STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300679417",
            "telephone_number": "709-809-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADIBE",
        "first_name": "JEREMY",
        "middle_name": "ERIC",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-28",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS037611",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN015617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080804",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David R. Haburchak, MD
• Eddie Hackler III, M.D.
• Edmond F. Hackney, RPH
• Melanie Hackney, PMHNP-BC
• Shana Boyd Hackworth, PHYSICIAN ASSISTANT
• Charles R Haendel, DPM
• Joseph Vance Haezebrouck, D.C.
• David H. Hafner, M.D.
• Colleen L Hagan
• Terris Leigh Hagan

• Oral and Maxillofacial Surgery (Dentist) in Marietta, GA
• Providers in Marietta, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.