Healthcare Provider Details

I. General information

NPI: 1417325259
Provider Name (Legal Business Name): VANESSA KEMP DEAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA KEMP

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD MOB I SUITE 205
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

830 HEARD AVE
AUGUSTA GA
30904-4206
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-2369
  • Fax:
Mailing address:
  • Phone: 706-993-6082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: