1407835705 NPI number — DR. GEOFFREY S DEUTSCH MD

Table of content: DR. GEOFFREY S DEUTSCH MD (NPI 1407835705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407835705 NPI number — DR. GEOFFREY S DEUTSCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEUTSCH
Provider First Name:
GEOFFREY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407835705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MIMOSA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-226-8881
Provider Business Mailing Address Fax Number:
229-225-2165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MIMOSA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-226-8881
Provider Business Practice Location Address Fax Number:
229-225-2165
Provider Enumeration Date:
01/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  045061 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 045061 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 377888 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000867622E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000867622B . This is a "PEACH STATE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000867622B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020054151 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".