Healthcare Provider Details

I. General information

NPI: 1033374392
Provider Name (Legal Business Name): JAMES BRADFORD DEPEW MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD STE 470
SANDY SPRINGS GA
30342-1776
US

IV. Provider business mailing address

5673 PEACHTREE DUNWOODY RD STE 470
SANDY SPRINGS GA
30342-1776
US

V. Phone/Fax

Practice location:
  • Phone: 678-752-7842
  • Fax: 678-374-7327
Mailing address:
  • Phone: 678-752-7842
  • Fax: 678-374-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number078473
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: