Healthcare Provider Details

I. General information

NPI: 1659893139
Provider Name (Legal Business Name): JAMES B DEPEW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
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: JAMES BRADFORD DEPEW
Title or Position: OWNER
Credential: MD FACS
Phone: 678-752-7842