Gregg R Codelli, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

10306 Issued in GA

Practice address

1707A Mount Vernon Rd
Atlanta, GA 30338-4207

Phone

(770) 668-0604

Fax

(770) 234-4065

NPI assigned

Jan 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821141870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3941 GLENNCREST CT NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303191893",
            "telephone_number": "770-668-0604",
            "fax_number": "770-234-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707A MOUNT VERNON RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303384207",
            "telephone_number": "770-668-0604",
            "fax_number": "770-234-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CODELLI",
        "first_name": "GREGG",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "10306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shenita Michelle Cochran, PHARMD
• Reid Cochrane, RBT
• Karen Nichole Cockerham, LCSW
• Ann C Coco, MSW, LCSW, CMH
• Loian Chambers Coco, DO
• Bria K Coder
• Coders USA
• Jesse Alexander Codner, MD
• Christian Alexander Cody, PA-C
• Rayden Chandler Cody, M.D.

• Periodontics in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.