Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 078473 | GA |
NPI | 1033374392 |
---|---|
Provider Name | Dr. James Bradford Depew |
First Address | Marietta, GA 30060-7358 |
Second Address | Marietta, GA 30060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 24/08/2018 |