Provider Demographics
NPI:1538131313
Name:DEAL, DAVEY R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVEY
Middle Name:R
Last Name:DEAL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:310 HOSPITAL DR
Mailing Address - Street 2:SUITE305
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3895
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-741-3631
Practice Address - Street 1:310 HOSPITAL DR
Practice Address - Street 2:SUITE305
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3895
Practice Address - Country:US
Practice Address - Phone:478-338-9200
Practice Address - Fax:478-741-5631
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-09-21
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Provider Licenses
StateLicense IDTaxonomies
GA046076207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000835084AMedicaid
GAH00726Medicare UPIN
GA10BDHFPMedicare ID - Type Unspecified