Provider Demographics
NPI:1093771545
Name:BIRDSONG, DEARL V JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DEARL
Middle Name:V
Last Name:BIRDSONG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1631
Mailing Address - Country:US
Mailing Address - Phone:706-297-7877
Mailing Address - Fax:877-586-0142
Practice Address - Street 1:218 FALLS RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-1631
Practice Address - Country:US
Practice Address - Phone:706-297-7877
Practice Address - Fax:877-586-0142
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063171208600000X
AL25152208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51112487OtherBCBS NEW ISSUE
GA000044337AMedicaid