Provider Demographics
NPI:1659719722
Name:DEEN, RAYMOND WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:DEEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2674
Mailing Address - Country:US
Mailing Address - Phone:478-453-9346
Mailing Address - Fax:478-453-0205
Practice Address - Street 1:800 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2674
Practice Address - Country:US
Practice Address - Phone:478-453-9346
Practice Address - Fax:478-453-0205
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
GA74716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program