NPIMap

Organization Active NPI

K. Clay Ellis, Jr., DMD, LLC

  • General Practice Dentistry
  • Gadsden, AL
National Provider Identifier
1770229650
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
K. CLAY ELLIS, JR., DMD, LLC
Practice address
311 S 5TH St Ste a
Gadsden, AL 35901-4253
Phone
(256) 543-1285
Fax
(256) 543-1719
NPI assigned
May 12, 2022
Last updated
Jun 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Authorized official

Name
Amanda Gregory
Title
Office Manager
Phone
(256) 543-1285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

311 S 5TH St Ste a
Gadsden, AL 35901-4253

Mailing address

311 S 5TH St Ste a
Gadsden, AL 35901-4253
Phone (256) 543-1285

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1770229650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 S 5TH ST STE A",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359014253",
            "telephone_number": "256-543-1285",
            "fax_number": "256-543-1719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 S 5TH ST STE A",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359014253",
            "telephone_number": "256-543-1285",
            "fax_number": "256-543-1719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K. CLAY ELLIS, JR., DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-12",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "256-543-1285"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gadsden, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.