Active NPI
John Stuart Dirksen, MD
- Psychiatry Physician
- Evans, GA
National Provider Identifier
1679570147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 033771
- Practice address
- 104 B SRP Dr
Evans, GA 30809-3319 - Phone
- (706) 210-8400
- Fax
- (706) 210-8311
- NPI assigned
- Jun 30, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 033771 | GA | Primary |
Addresses
Primary practice location
104 B SRP Dr
Evans, GA 30809-3319
Mailing address
104 B SRP Dr
Evans, GA 30809-3319
Phone (706) 210-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 260048595 | Other | GA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061010000293 | GA | Practitioner - Psychiatry | 3870599160 | Practice locations: Evans, GA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349222400000",
"number": "1679570147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 B SRP DR",
"city": "EVANS",
"state": "GA",
"postal_code": "308093319",
"telephone_number": "706-210-8400",
"fax_number": "706-210-8311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 B SRP DR",
"city": "EVANS",
"state": "GA",
"postal_code": "308093319",
"telephone_number": "706-210-8400",
"fax_number": "706-210-8311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIRKSEN",
"first_name": "JOHN",
"middle_name": "STUART",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2012-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "033771",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "260048595",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
- Kathy Dexter, PA-C
- Diakon, Inc. (Integrity Hospice)
- Madison Anne Dickey, CF-SLP
- Kristen M Dietert, CRC
- Sohailla Digsby, RD
- Deanna Faye Dixon
- Melanie Simon Dobbs, NP
- Doctors Hospital Center for Occupational Medicine (Center for Occupational Medicine)
- Doctors Hospital of Augusta, LLC (Evans Emergency, a department of Doctors Hospital of Augusta)
- Gregory Dodds
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.