Healthcare Provider Details

I. General information

NPI: 1902896467
Provider Name (Legal Business Name): RALPH H. DEAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 BATTLEFIELD PKWY
FORT OGLETHORPE GA
30742-4009
US

IV. Provider business mailing address

1131 STRINGER RIDGE RD UNIT 8 J
CHATTANOOGA TN
37405-3255
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-7810
  • Fax:
Mailing address:
  • Phone: 423-752-3061
  • Fax: 706-861-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number008418
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: