Provider Demographics
NPI:1659893139
Name:JAMES B DEPEW MD PC
Entity Type:Organization
Organization Name:JAMES B DEPEW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEPEW, M.D. P.C.
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:770-421-1242
Mailing Address - Street 1:120 VANN ST NE STE 150
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7358
Mailing Address - Country:US
Mailing Address - Phone:770-421-1242
Mailing Address - Fax:770-424-6652
Practice Address - Street 1:120 VANN ST NE STE 150
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-421-1242
Practice Address - Fax:770-424-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0784732086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty