Leonard Davey Deramus, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001541 Issued in GA

Practice address

55 Carlton St
Athens, GA 30602-1503

Phone

(706) 542-8609

NPI assigned

Dec 7, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358294400000",
    "number": "1073598645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 CARLTON ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306021503",
            "telephone_number": "706-542-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 CARLTON ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306021503",
            "telephone_number": "706-542-8609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERAMUS",
        "first_name": "LEONARD",
        "middle_name": "DAVEY",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2013-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "001541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000261093B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Edward Dempsey, M.D.
• Fiona Noelle Denham, MD
• Bruno Oscar Denis, MD
• Griffin Dalton Dennison
• Dental Sleep Medicine of Ga PC
• Dermatology of Athens, P.C.
• Dermatology Specialists of Georgia, LLC
• Margi Desai, DO
• Rajiv Dinkar Desai, M.D. OBGYN
• Anne Desmond, FNP

• Physician Assistant in Athens, GA
• Providers in Athens, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.