Active NPI
Divya Reddy Raina, D.D.S.
- Dentist
- Duluth, GA
National Provider Identifier
1811154289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 011742
- Practice address
- 4390 Pleasant Hill Rd
Suite a
Duluth, GA 30096-8054 - Phone
- (770) 622-9772
- Fax
- (770) 622-6446
- NPI assigned
- May 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 011742 | GA | Primary |
Addresses
Primary practice location
4390 Pleasant Hill Rd
Suite a
Duluth, GA 30096-8054
Mailing address
4390 Pleasant Hill Rd
Suite a
Duluth, GA 30096-8054
Phone (770) 622-9772
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011742 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1811154289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4390 PLEASANT HILL RD",
"address_2": "SUITE A",
"city": "DULUTH",
"state": "GA",
"postal_code": "300968054",
"telephone_number": "770-622-9772",
"fax_number": "770-622-6446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4390 PLEASANT HILL RD",
"address_2": "SUITE A",
"city": "DULUTH",
"state": "GA",
"postal_code": "300968054",
"telephone_number": "770-622-9772",
"fax_number": "770-622-6446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAINA",
"first_name": "DIVYA",
"middle_name": "REDDY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-21",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "011742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.