Active NPI
John Haycock, D.M.D.
- Endodontics
- Fayetteville, GA
National Provider Identifier
1992093801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN014171
- Practice address
- 112 N Park Dr
Fayetteville, GA 30214-1645 - Phone
- (770) 460-1527
- NPI assigned
- Jul 12, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN014171 | GA | Primary |
Addresses
Primary practice location
112 N Park Dr
Fayetteville, GA 30214-1645
Mailing address
315 Swains Dr
Fayetteville, GA 30215-5789
Phone (706) 877-3456
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 |
|---|---|---|---|
| DN014171 | GA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Haycock Endodontics, Inc. | Current | 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
- Fayetteville, GA
- NPI 1205503398
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403740800000",
"number": "1992093801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 SWAINS DR",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302155789",
"telephone_number": "706-877-3456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 N PARK DR",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302141645",
"telephone_number": "770-460-1527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYCOCK",
"first_name": "JOHN",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-12",
"last_updated": "2014-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "GA",
"license": "DN014171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.