Provider Demographics
NPI:1922358191
Name:JAMES H DEW JR MD PC
Entity Type:Organization
Organization Name:JAMES H DEW JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-938-1705
Mailing Address - Street 1:2200 NORTHLAKE PARKWAY
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 NORTHLAKE PARKWAY
Practice Address - Street 2:SUITE 300A
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-938-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000077118EMedicaid
GAD45520Medicare UPIN
253663630DMedicare PIN