Individual provider Active NPI

Jayne Kelly Labuda, D.M.D.

  • General Practice Dentistry
  • Macon, GA
National Provider Identifier
1689921991
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN014411 Issued in GA
Practice address
4226 Hartley Bridge Rd Ste 102
Macon, GA 31216-4116
Phone
(478) 621-7657
NPI assigned
Aug 7, 2012
Last updated
Jan 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN014411 GA Primary

Addresses

Primary practice location

4226 Hartley Bridge Rd Ste 102
Macon, GA 31216-4116

Mailing address

4226 Hartley Bridge Rd Ste 102
Macon, GA 31216-4116
Phone (478) 621-7657

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

LicenseStateTypeSpecialty
DN014411GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Hartley Bridge Family Dentistry General Practice CurrentSince Feb 1, 2022 Accepting new patients
Sequoia Dental Assisting School CurrentSince Dec 18, 2022 Accepting new patients

Locations

4226 Hartley Bridge Rd
Ste 102
Macon, GA 31216
Phone (478) 621-7657

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1689921991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4226 HARTLEY BRIDGE RD STE 102",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312164116",
            "telephone_number": "478-621-7657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4226 HARTLEY BRIDGE RD STE 102",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312164116",
            "telephone_number": "478-621-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABUDA",
        "first_name": "JAYNE",
        "middle_name": "KELLY",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-07",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.