Provider Demographics
NPI:1780625293
Name:WORKMAN, DENISE (DO)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CANTRELL RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528
Mailing Address - Country:US
Mailing Address - Phone:706-348-8763
Mailing Address - Fax:706-348-1931
Practice Address - Street 1:55 CANTRELL RD
Practice Address - Street 2:STE. 100
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528
Practice Address - Country:US
Practice Address - Phone:706-348-8763
Practice Address - Fax:706-348-1931
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH90201Medicare UPIN
GA08BBQGXMedicare PIN