Healthcare Provider Details

I. General information

NPI: 1215828579
Provider Name (Legal Business Name): KORAL F DEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DOCTORS PARK
CAIRO GA
39828-3072
US

IV. Provider business mailing address

998 TRINITY RD
WHIGHAM GA
39897-2990
US

V. Phone/Fax

Practice location:
  • Phone: 229-378-8110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP297365
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN297365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: