EISENHOWER PARKWAY DENTAL GROUP, LLC (NPI# 1073063228) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073063228 |
| Entity Type | Organization |
| Organization Name | EISENHOWER PARKWAY DENTAL GROUP, LLC |
| Other Organization Name | YOUTH DENTISTRY OF MACON |
| Practice Address |
1536 Eisenhower Pkwy Macon GA 31206 |
| Mailing Address |
401 Church St Ste 2210 Nashville TN 37219-2204 |
| Practice Telephone | 4787814333 |
| Practice Fax Number | 4787814331 |
| Mailing Telephone | 6159882627 |
| Mailing Fax Number | 6318577860 |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2018-07-05 |
| Authorized Official Name | LINDA SUSAN ZOELLER (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 6159882627 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN015152 | GA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Youth Dentistry of Macon | Doing Business As Name - Organization |
| Street Address |
1536 EISENHOWER PKWY |
| City | MACON |
| State | GA |
| Zip Code | 31206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851366462 | Youth Dentistry of Macon, PC | Dentist | 1536 Eisenhower Pkwy, Macon, GA 31206-3130 | 2006-02-18 |
| 1326250762 | Scott Carl Farrell | Dentist | 1536 Eisenhower Pkwy, Macon, GA 31206-3130 | 2007-05-06 |
| 1457497414 | Tara Lynn Brooks | Dentist | 1536 Eisenhower Pkwy, Macon, GA 31206-3130 | 2007-01-29 |
| 1285745505 | Andrea Davis Wood | Dentist | 1536 Eisenhower Pkwy, Macon, GA 31206-3130 | 2006-08-31 |
| 1154364396 | Phoeby K Lewis | Dentist | 1536 Eisenhower Pkwy, Macon, GA 31206-3130 | 2006-06-14 |
| 1023083631 | Michelle S Gwyn | Dentist | 1536 Eisenhower Pkwy, Macon, GA 31206-3130 | 2006-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992267892 | Andel Anthony Higgins | Family Medicine | 3780 Eisenhower Parkway, Macon, GA 31206 | 2019-04-01 |
| 1437651924 | Amanda Mckenzie | Clinic/Center | Us Renal Care 657 Hemlock Street, Macon, GA 31206 | 2018-03-01 |
| 1003337718 | Shantha Tyhessia Jones | Home Health | 2453 Shea Drive, Macon, GA 31206 | 2017-07-03 |
| 1043683527 | Autumn Anderson Lucas | Nurse Practitioner | 100 University Parkway, Macon, GA 31206 | 2015-11-05 |
| 1306273651 | Monique Whipple | Speech-Language Pathologist | 164 Summer Grove Lane, Macon, GA 31206 | 2013-10-02 |
| 1710956750 | Total Renal Care Inc | Clinic/Center | 2494 2nd St, Macon, GA 31206 | 2006-03-14 |
| 1396710828 | Ruth Macphie Hagemann | Counselor | 100 University Pkwy, Macon, GA 31206 | 2006-02-20 |
| 1609861129 | Rickey Harton Jr. | Optometrist | 3353 Mercer University Drive, Macon, GA 31206 | 2005-09-12 |
| 1104453711 | Lise Wendy Forestal | Student in an Organized Health Care Education/Training Program | 3780 Eisenhower Parkway, Macon, GA 31206 | 2020-03-24 |
| 1346702172 | Alayna Dukes | Family Medicine | 3780 Eisenhower Pkwy, Macon, GA 31206 | 2019-04-01 |
| Find all providers in zip 31206 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891224861 | Joshua Buckner | Dentist | 4562 Forsyth Rd # 1, Macon, GA 31210-0510 | 2017-06-05 |
| 1679029938 | Gamble Dentalsmart, PC | Dentist | 236 Tom Hill Sr. Blvd., Macon, GA 31210-1815 | 2016-08-28 |
| 1295189595 | Providence Dental LLC | Dentist | 225 N Macon St, Macon, GA 31210-6562 | 2016-04-22 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1497001630 | Samer Mufid Othman | Dentist | 4705 Northside Dr, Suite 100, Macon, GA 31210-1698 | 2012-07-25 |
| 1881959518 | Leigh Underwood Bennett | Dentist | 4226 Hartley Bridge Rd Ste 102, Macon, GA 31216 | 2012-07-09 |
| 1285912527 | Steven N Golubow | Dentist | 6443 Zebulon Rd, Suite 3a and B, Macon, GA 31220-7638 | 2011-08-03 |
| 1497981658 | Mitchell Dental Clinic, Inc. | Dentist | 59 Frontage Rd N, Macon, MS 39341-2372 | 2009-06-02 |
| 1740496280 | John N Bowman Ddspc | Dentist | 133 Lamar St, Macon, GA 31204-3007 | 2007-05-14 |
| 1407060452 | Marion Hall Gray | Dentist | 102 W 8th St, Macon, MS 39341-2624 | 2007-05-09 |
| Find all providers in MACON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.