Provider Demographics
NPI:1407835705
Name:DEUTSCH, GEOFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:S
Last Name:DEUTSCH
Suffix:
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 1:100 MIMOSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792
Mailing Address - Country:US
Mailing Address - Phone:229-226-8881
Mailing Address - Fax:229-225-2165
Practice Address - Street 1:100 MIMOSA DRIVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-226-8881
Practice Address - Fax:229-225-2165
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045061174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA377888OtherWELLCARE
GA000867622EMedicaid
GA000867622BOtherPEACH STATE
GA000867622BMedicaid
GA020054151OtherRAILROAD MEDICARE
GA000867622BMedicaid
GA000867622BOtherPEACH STATE
GA000867622EMedicaid