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General NPI Number Information
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NPI Number | 1285717942
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Entity Type | Individual
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Provider Name | DEEPTI JAIN BHASIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 402 OSIGIAN BLVD SUTIE 400
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8988
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Country | US
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Telephone | 478-333-3058
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Fax | 478-333-3496
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Provider Business Mailing Address
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Address Line | 402 OSIGIAN BLVD SUTIE 400
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8988
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Country | US
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Telephone | 478-333-3058
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Fax | 478-333-3496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | 28166
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 059979
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | 059979
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD28166
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License Number State | SC
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