Provider Demographics
NPI:1770697989
Name:DEARIE, JOSEPH C (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:DEARIE
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 1:5665 NEW NORTHSIDE DR NW
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5831
Mailing Address - Country:US
Mailing Address - Phone:770-874-5400
Mailing Address - Fax:770-874-5469
Practice Address - Street 1:1850 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-217-3252
Practice Address - Fax:815-758-5348
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056700207P00000X
IL036089746207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA476932038CMedicaid
GA476932038BMedicaid
GA476932038AMedicaid
GA476932038DMedicaid
GA93BFBNDMedicare ID - Type UnspecifiedMEDICARE KCPD
GA476932038CMedicaid