Healthcare Provider Details

I. General information

NPI: 1033374392
Provider Name (Legal Business Name): JAMES BRADFORD DEPEW MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 OLD MILTON PKWY STE 260
ALPHARETTA GA
30005-4626
US

IV. Provider business mailing address

3333 OLD MILTON PKWY STE 260
ALPHARETTA GA
30005-4626
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-0695
  • Fax: 877-592-3455
Mailing address:
  • Phone: 770-772-0695
  • Fax: 877-592-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number078473
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: