NPIMap

Organization Active NPI

James R. Deatherage D.M.D.,P.C.

  • Dentist
  • Brewton, AL
National Provider Identifier
1730404187
Registry record updated Mar 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4913 Issued in AL
Legal business name
JAMES R. DEATHERAGE D.M.D.,P.C.
Practice address
422 Douglas Ave
Brewton, AL 36426-2052
Phone
(251) 867-6837
Fax
(251) 867-6278
NPI assigned
Mar 29, 2010
Last updated
Mar 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2010

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

Authorized official

Name
Mrs. Becky Jane Barrow
Title
Office Manager
Phone
(251) 867-6837

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4913 AL Primary

Addresses

Primary practice location

422 Douglas Ave
Brewton, AL 36426-2052

Mailing address

422 Douglas Ave
Brewton, AL 36426-2052
Phone (251) 867-6837

Other identifiers 3

IdentifierTypeStateIssuer
113806MedicaidAL
996355OtherPAUNITED CONCORDIA
510-67264OtherALBLUE CROSS & BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269820800000",
    "number": "1730404187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 DOUGLAS AVE",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364262052",
            "telephone_number": "251-867-6837",
            "fax_number": "251-867-6278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 DOUGLAS AVE",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364262052",
            "telephone_number": "251-867-6837",
            "fax_number": "251-867-6278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES R. DEATHERAGE D.M.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-29",
        "last_updated": "2010-03-29",
        "status": "A",
        "authorized_official_last_name": "BARROW",
        "authorized_official_first_name": "BECKY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "251-867-6837",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "4913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113806",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "996355",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "510-67264",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brewton, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; 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.