Provider Demographics
NPI:1013199637
Name:WORTHINGSTUN, DEAN DALE (DO)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:DALE
Last Name:WORTHINGSTUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 E MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-7139
Mailing Address - Country:US
Mailing Address - Phone:706-946-7300
Mailing Address - Fax:706-946-7305
Practice Address - Street 1:980 E MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-7139
Practice Address - Country:US
Practice Address - Phone:706-946-7300
Practice Address - Fax:706-946-7305
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66676208600000X, 2086S0105X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003115964Medicaid
GA003115964Medicaid