NPIMap

Organization Active NPI

Edward J Green DMD PC

  • General Practice Dentistry
  • Albany, GA
National Provider Identifier
1770657124
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN09807 Issued in GA
Legal business name
EDWARD J GREEN DMD PC
Practice address
1505 W Third Avenue
Suite B
Albany, GA 31707-3647
Phone
(229) 883-3071
Fax
(229) 883-5184
NPI assigned
Nov 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Edward James Green, DOCTOR OF DENTAL MEDNPI 1902050412
Title
S Corp President
Phone
(229) 883-3071

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN09807 GA Primary

Addresses

Primary practice location

1505 W Third Avenue
Suite B
Albany, GA 31707-3647

Mailing address

PO Box 70907
Albany, GA 31708-0907
Phone (229) 883-3071

Other identifiers 1

IdentifierTypeStateIssuer
00267044BMedicaidGA

National Provider Directory

National Provider Directory

Locations

1505 W 3rd Ave
Ste B
Albany, GA 31707
Phone (229) 883-3071

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770657124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70907",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317080907",
            "telephone_number": "229-883-3071",
            "fax_number": "229-883-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W THIRD AVENUE",
            "address_2": "SUITE B",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317073647",
            "telephone_number": "229-883-3071",
            "fax_number": "229-883-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD J GREEN DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "S CORP PRESIDENT",
        "authorized_official_telephone_number": "229-883-3071",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DOCTOR OF DENTAL MED"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN09807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00267044B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.