Healthcare Provider Details

I. General information

NPI: 1104147081
Provider Name (Legal Business Name): DEEPTI BHASIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 OSIGIAN BLVD SUTIE 400
WARNER ROBINS GA
31088-8988
US

IV. Provider business mailing address

402 OSIGIAN BLVD SUTIE 400
WARNER ROBINS GA
31088-8988
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-3058
  • Fax: 478-333-3496
Mailing address:
  • Phone: 478-333-3058
  • Fax: 478-333-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEEPTI J BHASIN
Title or Position: PRESIDENT
Credential: MD
Phone: 478-333-3058