NPIMap

Organization Active NPI

Palmetto Family Dental of Pike County

  • Dental Clinic/Center
  • Zebulon, GA
National Provider Identifier
1780017822
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DN013693 Issued in GA
Legal business name
PALMETTO FAMILY DENTAL OF PIKE COUNTY
Practice address
15988 Barnesville St.
Zebulon, GA 30295
Phone
(770) 567-8000
Fax
(770) 567-8600
NPI assigned
Aug 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
Dr. Jordan Albert Brunson, DDSNPI 1861631053
Title
President
Phone
(770) 567-8000

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
Dental Clinic/Center 261QD0000X DN013693 GA Primary

Addresses

Primary practice location

15988 Barnesville St.
Zebulon, GA 30295

Mailing address

15988 Barnesville St.
Zebulon, GA 30295
Phone (770) 567-8000

Other identifiers 1

IdentifierTypeStateIssuer
685019718CMedicaidGA

Other names 1

  • Palmetto Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

15988 Barnesville St
Zebulon, GA 30295
Phone (770) 567-8000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1780017822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15988 BARNESVILLE ST.",
            "city": "ZEBULON",
            "state": "GA",
            "postal_code": "30295",
            "telephone_number": "770-567-8000",
            "fax_number": "770-567-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15988 BARNESVILLE ST.",
            "city": "ZEBULON",
            "state": "GA",
            "postal_code": "30295",
            "telephone_number": "770-567-8000",
            "fax_number": "770-567-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO FAMILY DENTAL OF PIKE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-13",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "BRUNSON",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-567-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN013693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "685019718C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmetto Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Zebulon, GA

Sources for this page

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