Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 66676 | GA |
N | 208200000X | Surgeon | 66676 | GA |
N | 208600000X | Surgeon | 66676 | GA |
N | 2086S0105X | Surgery of the Hand | 66676 | GA |
NPI | 1013199637 |
---|---|
Provider Name | Dr. Dean Dale Worthingstun |
First Address | Blue Ridge, GA 30513-7139 |
Second Address | Blue Ridge, GA 30513-7139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003115964 | (05) | GA |