Jared Wilson Bristol

Primary specialty

DentistTaxonomy code 122300000X

License

DN015049 Issued in GA

Practice address

573 Concord Rd SE Ste C
Smyrna, GA 30082-2611

Phone

(770) 435-9046

NPI assigned

Dec 5, 2017

Last updated

Dec 5, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Jennings W Bristol DDS PC

  • Dentist
  • Smyrna, GA
  • NPI 1952816373
  NPD (past) Authorized official

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512432000000",
    "number": "1962917575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "573 CONCORD RD SE STE C",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300822611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "573 CONCORD RD SE STE C",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300822611",
            "telephone_number": "770-435-9046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTOL",
        "first_name": "JARED",
        "middle_name": "WILSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-05",
        "last_updated": "2017-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN015049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DN015049",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael E. Breazeale, D.C.
• John Bremner, MSN,APRN, PMHNP-BC
• Scott Curtis Brennan, PA
• Bridgepoint Clinic (Bridgepoint)
• Brilliant Eyes, LLC (Brilliant Eyes Vision Center)
• Jennings Wilson Bristol, DDS
• Kristne Danielle Broadway, LPC
• Brianna Tinia Brooks, LCSW
• Christopher Kyle Brooks, D.C.
• Amber Brown, PHARM.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; 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.