Walker Thomas Pendarvis, DMD, MHS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN013482 Issued in GA

Practice address

6600 Abercorn St
Suite 204
Savannah, GA 31405-5800

Phone

(912) 349-3259

Fax

(912) 358-0008

NPI assigned

Sep 20, 2006

Last updated

Jun 20, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• 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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1700983723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 ABERCORN ST",
            "address_2": "SUITE 204",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314055800",
            "telephone_number": "912-349-3259",
            "fax_number": "912-358-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 ABERCORN ST",
            "address_2": "SUITE 204",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314055800",
            "telephone_number": "912-349-3259",
            "fax_number": "912-358-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDARVIS",
        "first_name": "WALKER",
        "middle_name": "THOMAS",
        "credential": "DMD, MHS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "3953",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013482",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "SC",
            "license": "0646",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "DN013482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Anne Peigh, N.P.
• Hamilton Peirsol, PSY.D.,C.A.P.,ICAADC
• Edward Pellicano
• Amber Lilia Pellington, NP
• Mary Ashley Pemberton, AA
• Seneca Pender, LICSW
• Andrew L. Pendleton, MD
• Miriam R Pendleton, O.D.
• Mary Elizabeth Pennington, PTA
• Jenny Pennino, RN

• Periodontics in Savannah, GA
• Providers in Savannah, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.