Provider Demographics
NPI:1841301900
Name:DEEN, KENNETH MURRAY (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MURRAY
Last Name:DEEN
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 1:232 CHEROKEE ROAD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286
Mailing Address - Country:US
Mailing Address - Phone:706-647-8138
Mailing Address - Fax:706-647-8745
Practice Address - Street 1:232 CHEROKEE ROAD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286
Practice Address - Country:US
Practice Address - Phone:706-647-8138
Practice Address - Fax:706-647-8745
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048999207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA180041451OtherRR MEDICARE
GA000896695AMedicaid
GA0872710001OtherPALMETTO
GA000896695AMedicaid
GA0872710001Medicare NSC
H31488Medicare UPIN