Active NPI
Gwendolyn T Dean, M.D.
- Specialist
- Fayetteville, GA
National Provider Identifier
1629028386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 28526
- Practice address
- 115 Sumner Rd
Fayetteville, GA 30214-4758 - Phone
- (678) 477-6904
- NPI assigned
- May 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 28526 | GA | Primary |
Addresses
Primary practice location
115 Sumner Rd
Fayetteville, GA 30214-4758
Mailing address
PO Box 56158
Atlanta, GA 30343-0158
Phone (404) 307-9575
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00297349AL | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28526 | GA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629028386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 56158",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303430158",
"telephone_number": "404-307-9575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 SUMNER RD",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302144758",
"telephone_number": "678-477-6904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAN",
"first_name": "GWENDOLYN",
"middle_name": "T",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "28526",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00297349AL",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.