Active NPI
Dean Carl Broome, M.D,
- Legal Medicine (M.D./D.O.) Physician
- Blackshear, GA
National Provider Identifier
1356548002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Legal Medicine (M.D./D.O.) Physician
- License
- 048604
- Practice address
- 115 Main St
Blackshear, GA 31516-0271 - Phone
- (912) 449-1477
- Fax
- (912) 449-1479
- NPI assigned
- Jun 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 048604 | GA | |
| Pediatrics Physician | 208000000X | 048604 | GA | |
| Pediatric Adolescent Medicine Physician | 2080A0000X | 048604 | GA | |
| Pediatric Endocrinology Physician | 2080P0205X | 048604 | GA | |
| Legal Medicine (M.D./D.O.) Physician | 209800000X | 048604 | GA | Primary |
Addresses
Primary practice location
115 Main St
Blackshear, GA 31516-0271
Mailing address
115 Main St
PO Box 271
Blackshear, GA 31516-0271
Phone (912) 449-1477
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00886872A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048604 | GA | MD | Legal Medicine (M.D./D.O.) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1356548002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 MAIN ST",
"address_2": "PO BOX 271",
"city": "BLACKSHEAR",
"state": "GA",
"postal_code": "315160271",
"telephone_number": "912-449-1477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 MAIN ST",
"city": "BLACKSHEAR",
"state": "GA",
"postal_code": "315160271",
"telephone_number": "912-449-1477",
"fax_number": "912-449-1479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOME",
"first_name": "DEAN",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "M.D,",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-27",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "048604",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "048604",
"primary": false
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "GA",
"license": "048604",
"primary": false
},
{
"code": "2080P0205X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Endocrinology",
"state": "GA",
"license": "048604",
"primary": false
},
{
"code": "209800000X",
"taxonomy_group": "",
"desc": "Legal Medicine",
"state": "GA",
"license": "048604",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00886872A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blackshear, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.