Healthcare Provider Details

I. General information

NPI: 1962570481
Provider Name (Legal Business Name): VICTOR ALAN DEWYEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD FL 8
FORT EISENHOWER GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-4154
  • Fax: 706-787-2554
Mailing address:
  • Phone: 706-787-4154
  • Fax: 706-787-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number200000204
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number200000204
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number200000204
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: