Active NPI
Paul Emerson Gannon, D.M.D.
- Dentist
- Gainesville, GA
National Provider Identifier
1902238926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN014640
- Practice address
- 1026 Thompson Bridge Rd
Gainesville, GA 30501-1704 - Phone
- (770) 297-0401
- NPI assigned
- Aug 1, 2013
- Sex
- Male
- Sole proprietor
- No
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 | DN014640 | GA | Primary |
Addresses
Primary practice location
1026 Thompson Bridge Rd
Gainesville, GA 30501-1704
Mailing address
1026 Thompson Bridge Rd
Gainesville, GA 30501-1704
Phone (770) 297-0401
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 |
|---|---|---|---|
| DN014640 | GA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gainesville Dental Group | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Gainesville, GA
- NPI 1114181138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467676800000",
"number": "1902238926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1026 THOMPSON BRIDGE RD",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305011704",
"telephone_number": "770-297-0401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1026 THOMPSON BRIDGE RD",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305011704",
"telephone_number": "770-297-0401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "PAUL",
"middle_name": "EMERSON",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-01",
"last_updated": "2016-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN014640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.