Healthcare Provider Details

I. General information

NPI: 1396037727
Provider Name (Legal Business Name): USMEDX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 OSIGIAN BLVD SUTIE 300
WARNER ROBINS GA
31088-8922
US

IV. Provider business mailing address

PO BOX 8778
WARNER ROBINS GA
31095-8778
US

V. Phone/Fax

Practice location:
  • Phone: 478-365-2830
  • Fax:
Mailing address:
  • Phone: 478-365-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number016707
License Number StateGA

VIII. Authorized Official

Name: DR. CHARLIE W DEAN
Title or Position: MEMBER
Credential: M.D.
Phone: 478-365-2830