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NPI Code Detail

MEDICARE: DR. ETHAN WESLEY DEAN MD

MEDICARE: DR. ETHAN WESLEY DEAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician89800GA
2207XS0106XOrthopaedic Hand Surgery Physician89800GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093133894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ETHAN WESLEY DEAN MD
Provider Business Mailing Address
First Line : 620 CHEROKEE ST NE STE 300
Second Line :
City : MARIETTA
State : GA
Zip : 30060-7233
Country : US
Telephone Number : 770-635-1812
Fax Number : 770-485-2883
Provider Business Practice Location Address
First Line : 620 CHEROKEE ST NE STE 300
Second Line :
City : MARIETTA
State : GA
Zip : 30060-7233
Country : US
Telephone Number : 770-635-1812
Fax Number : 770-485-2883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2014
Last Update Date : 10/31/2025

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Directions to “ DR. ETHAN WESLEY DEAN MD” Practice Location

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