Timothy B. Fagan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN011154 Issued in GA

Practice address

7 Long Leaf Office Park
Moultrie, GA 31768-6781

Phone

(229) 985-4674

NPI assigned

Jun 24, 2008

Last updated

Jun 24, 2008By the provider in NPPES

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Timothy B Fagan DMD PC

  • Dentist
  • Moultrie, GA
  • NPI 1982717369
  NPD (past) Authorized official

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1871754614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317760160",
            "telephone_number": "229-985-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 LONG LEAF OFFICE PARK",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686781",
            "telephone_number": "229-985-4674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "TIMOTHY",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Elliott, NP-C
• Margarett Conklin Ellison, M.D.
• Thomas L Estes, M.D.,F.A.C.S.
• Eleanor Delores Esther
• Sarah Britney Exum, NP
• Anna Marie Faircloth, OTR/L
• Jonathan Fairley, MD
• Family Recovery of Southwest Georgia
• Valarie Gay Farmer
• Farrey Family Dentistry LLC

• General Practice Dentistry in Moultrie, GA
• Providers in Moultrie, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.