Antwan Londell Treadway, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12209 Issued in GA

Practice address

1790 Mulkey Rd
Suite 3a
Austell, GA 30106-1122

Phone

(770) 941-2476

Fax

(770) 941-5710

NPI assigned

Aug 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

Other, 1993

Medicare assignment

May accept Medicare assignment

Group practices

Atlanta Oral and Facial Surgery LLCGroup PAC ID 8628062387, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emory Decatur Hospital Hospital, Decatur, GA, CCN 110076
• Wellstar Douglas Medical Center Hospital, Douglasville, GA, CCN 110184

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1992738165
  Medicare reassignment Care Compare group NPD
• Au Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Augusta, GA
  • NPI 1841733326
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dekalb Medical Center, Inc.

  dba Emory Decatur Hospital

  • General Acute Care Hospital
  • Decatur, GA
  • NPI 1093716979
  Care Compare affiliation
• Douglas Hospital, Inc.

  dba Wellstar Douglas Hospital

  • General Acute Care Hospital
  • Douglasville, GA
  • NPI 1649247974
  Care Compare affiliation

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972616878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 MULKEY RD",
            "address_2": "SUITE 3A",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061122",
            "telephone_number": "770-941-2476",
            "fax_number": "770-941-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 MULKEY RD",
            "address_2": "SUITE 3A",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061122",
            "telephone_number": "770-941-2476",
            "fax_number": "770-941-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREADWAY",
        "first_name": "ANTWAN",
        "middle_name": "LONDELL",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "12209",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN13765",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000849439B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000849439C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Athara Toussaint, NP
• Ryan Townsend
• Tiffany Leeann Townsend
• Melissa Trahan, PHARMD
• Shannon A Traywick, LPC
• Tri Star Ambulance LLC
• Trucquynh Truong
• Alana Tucker
• Linda Turberville-Trujillo, NP
• Takiyah Johnson Turks, APRN

• Oral and Maxillofacial Surgery (Dentist) in Austell, GA
• Providers in Austell, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.