Provider Demographics
NPI:1780750992
Name:ALAN P DEESE MD PC
Entity type:Organization
Organization Name:ALAN P DEESE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-741-7441
Mailing Address - Street 1:420 CHARTER BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-741-7441
Mailing Address - Fax:478-741-7465
Practice Address - Street 1:420 CHARTER BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-741-7441
Practice Address - Fax:478-741-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52650819OtherBCBS
G57817Medicare UPIN
GA52650819OtherBCBS