Kim Bradley Hood, DMD PC

Primary specialty

DentistTaxonomy code 122300000X

License

DN010794 Issued in GA

Practice address

643 East Main Street
Blackshear, GA 31516

Phone

(912) 449-6310

Fax

(912) 449-0009

NPI assigned

Nov 21, 2006

Sex

Male

Sole proprietor

No

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.

• Blackshear Dental Care, LLC

  • General Practice Dentistry
  • Blackshear, GA
  • NPI 1508492869
  NPD Authorized official
• Dr Kim Bradley Hood DMD PC

  • Dentist
  • Blackshear, GA
  • NPI 1316012636
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972678282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 EAST MAIN STREET",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "31516",
            "telephone_number": "912-449-6310",
            "fax_number": "912-449-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 EAST MAIN STREET",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "31516",
            "telephone_number": "912-449-6310",
            "fax_number": "912-449-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOOD",
        "first_name": "KIM",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "DMD PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN010794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00415423A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS",
            "identifier": "839938",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Blackshear, GA
• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.