Provider Demographics
NPI:1033374392
Name:DEPEW, JAMES BRADFORD (MD PC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRADFORD
Last Name:DEPEW
Suffix:
Gender:M
Credentials:MD PC
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Mailing Address - Street 1:120 VANN ST NE STE 150
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7358
Mailing Address - Country:US
Mailing Address - Phone:770-421-1242
Mailing Address - Fax:770-424-6652
Practice Address - Street 1:120 VANN ST NE STE 150
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-421-1242
Practice Address - Fax:770-424-6652
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0784732086S0122X
GA4041390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty