JLM Dentistry of Stockbridge

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013349 Issued in GA

Legal business name

JLM DENTISTRY OF STOCKBRIDGE

Practice address

3579 Highway 138 SE
Suite 202
Stockbridge, GA 30281-4142

Phone

(770) 474-6111

Fax

(770) 474-5897

NPI assigned

Jun 28, 2011

Organization subpart

No

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

Authorized official

Name

Jarrett L Manning, D.D.S./MPH

Title

Owner

Phone

(678) 640-5272

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1689960692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4450 S COBB DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806329",
            "telephone_number": "770-433-1515",
            "fax_number": "770-433-0039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3579 HIGHWAY 138 SE",
            "address_2": "SUITE 202",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814142",
            "telephone_number": "770-474-6111",
            "fax_number": "770-474-5897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JLM DENTISTRY OF STOCKBRIDGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-28",
        "last_updated": "2011-06-28",
        "status": "A",
        "authorized_official_last_name": "MANNING",
        "authorized_official_first_name": "JARRETT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-640-5272",
        "authorized_official_credential": "D.D.S./MPH"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; 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.