Active NPI
Ellison Smith, DDS
- General Practice Dentistry
- Atlanta, GA
National Provider Identifier
1720169451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11169
- Practice address
- 75 Marietta St NW
Suite 100
Atlanta, GA 30303-2883 - Phone
- (404) 577-0868
- Fax
- (404) 577-8096
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11169 | GA | Primary |
Addresses
Primary practice location
75 Marietta St NW
Suite 100
Atlanta, GA 30303-2883
Mailing address
75 Marietta St NW
Suite 100
Atlanta, GA 30303-2883
Phone (404) 577-0868
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00560645B | Medicaid | GA |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C S Dental | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720169451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 MARIETTA ST NW",
"address_2": "SUITE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303032883",
"telephone_number": "404-577-0868",
"fax_number": "404-577-8096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 MARIETTA ST NW",
"address_2": "SUITE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303032883",
"telephone_number": "404-577-0868",
"fax_number": "404-577-8096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "ELLISON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "11169",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00560645B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.