Healthcare Provider Details

I. General information

NPI: 1659893139
Provider Name (Legal Business Name): JAMES B DEPEW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
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

120 VANN ST NE STE 150
MARIETTA GA
30060-7358
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-0695
  • Fax: 877-592-3455
Mailing address:
  • Phone: 770-421-1242
  • Fax: 770-424-6652

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: DR. JAMES BRADFORD DEPEW
Title or Position: PLASTIC SURGEON / OWNER
Credential: MD FACS
Phone: 804-301-6168