MEDICARE: GWENDOLYN T DEAN M.D.

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
1	174400000X	Specialist	28526	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1629028386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN T DEAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 56158
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30343-0158
Country	:	US
Telephone Number	:	404-307-9575
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 SUMNER RD
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4758
Country	:	US
Telephone Number	:	678-477-6904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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