Active NPI
Shelly Mixson
- General Practice Dentistry
- Atlanta, GA
National Provider Identifier
1952467425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 012436
- Practice address
- 3528 Ashford Dunwoody Road
Atlanta, GA 30319 - Phone
- (770) 455-6602
- NPI assigned
- Dec 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 012436 | GA | Primary |
Addresses
Primary practice location
3528 Ashford Dunwoody Road
Atlanta, GA 30319
Mailing address
1133 E West Connector
Ste. 120 & 130
Austell, GA 30106-1589
Phone (770) 333-9951
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 |
|---|---|---|---|
| 012436 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas 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.
-
- Dental Clinic/Center
- Austell, GA
- NPI 1972042380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621468800000",
"number": "1952467425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1133 E WEST CONNECTOR",
"address_2": "STE. 120 & 130",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061589",
"telephone_number": "770-333-9951",
"fax_number": "770-333-9953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3528 ASHFORD DUNWOODY ROAD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30319",
"telephone_number": "770-455-6602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIXSON",
"first_name": "SHELLY",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2021-05-20",
"certification_date": "2021-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "012436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.