Provider Demographics
NPI:1033599949
Name:DEAN D. WORTHINGSTUN, DO, PC
Entity Type:Organization
Organization Name:DEAN D. WORTHINGSTUN, DO, PC
Other - Org Name:GEORGIA FOOTHILLS HAND SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WORTHINGSTUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-946-7300
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66676207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003115964DMedicaid