Healthcare Provider Details

I. General information

NPI: 1013199637
Provider Name (Legal Business Name): DEAN DALE WORTHINGSTUN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 10/11/2026
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 E MAIN ST SUITE 300
BLUE RIDGE GA
30513-7139
US

IV. Provider business mailing address

PO BOX 104
MORGANTON GA
30560-0104
US

V. Phone/Fax

Practice location:
  • Phone: 706-946-7300
  • Fax: 706-946-7305
Mailing address:
  • Phone: 706-946-7300
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number66676
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number66676
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number66676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: