MEDICARE: JAMES B DEPEW MD PC

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	2086S0122X	Plastic and Reconstructive Surgery Physician	078473	GA

General Provider Information

NPI Number	:	1659893139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES B DEPEW MD PC

Provider Business Mailing Address
First Line	:	981 FAIRFIELD DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2624
Country	:	US
Telephone Number	:	678-752-7842
Fax Number	:	804-487-4373

Provider Business Practice Location Address
First Line	:	980 JOHNSON FERRY RD STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1607
Country	:	US
Telephone Number	:	678-752-7842
Fax Number	:	804-487-4373

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES BRADFORD DEPEW
Credential	:	MD, FACS
Telephone Number	:	678-752-7842

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	03/27/2026

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