NPIMap

Organization Active NPI

Peach Family Dentistry,LLC

  • General Practice Dentistry
  • Fort Valley, GA
National Provider Identifier
1902017270
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN008283 Issued in GA
Legal business name
PEACH FAMILY DENTISTRY,LLC
Practice address
302 Knoxville St
Fort Valley, GA 31030-4251
Phone
(478) 825-3315
Fax
(478) 825-8396
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Dawson Kendrick Mathews, D.M.D.NPI 1578776456
Title
Owner
Phone
(478) 825-3315

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN008283 GA Primary

Addresses

Primary practice location

302 Knoxville St
Fort Valley, GA 31030-4251

Mailing address

302 Knoxville St
Fort Valley, GA 31030-4251
Phone (478) 825-3315

National Provider Directory

National Provider Directory

Locations

302 Knoxville St
Fort Valley, GA 31030
Phone (478) 825-3315

Practitioners & affiliated clinicians

Practitioners 3

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": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902017270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 KNOXVILLE ST",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310304251",
            "telephone_number": "478-825-3315",
            "fax_number": "478-825-8396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 KNOXVILLE ST",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310304251",
            "telephone_number": "478-825-3315",
            "fax_number": "478-825-8396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH FAMILY DENTISTRY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATHEWS",
        "authorized_official_first_name": "DAWSON",
        "authorized_official_middle_name": "KENDRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-825-3315",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN008283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Valley, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.