Tayler Yvette Keith Jackson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN122496 Issued in GA

Practice address

5140 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2745

Phone

(770) 439-1038

NPI assigned

Aug 28, 2019

Reactivated

Sep 23, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632441600000",
    "number": "1841848421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 JIMMY LEE SMITH PKWY",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301412745",
            "telephone_number": "770-439-1038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 JIMMY LEE SMITH PKWY",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301412745",
            "telephone_number": "770-439-1038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITH JACKSON",
        "first_name": "TAYLER",
        "middle_name": "YVETTE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-28",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "deactivation_date": "2021-09-13",
        "reactivation_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DC",
            "license": "DEN1002033",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "smile@hiramdentalgroup.com",
            "affiliation": "N",
            "address_1": "5140 Jimmy Lee Smith Pkwy",
            "city": "Hiram",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301412745",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dentist in Hiram, GA
• Providers in Hiram, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; 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.