Doctor Name: | WILLIE DEAN |
NPI Number: | 1720467574 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 41-2280333 |
Business Practice Address: | 1660 Peachtree St Nw #4308 Atlanta, GA - 303092470 |
Business Phone Number: | 4044888289 |
Business Fax Number: | |
Mailing Address: | 1660 Peachtree St Nw, #4308 ATLANTA |
State: | GA |
Postal Code: | 303092470 |
Phone Number: | 4044888289 |
Fax Number: | |
NPI Enumeration Date: | 05/27/2015 |
NPI Last Update Date: | 05/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | 41-2280333 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |