Basic Information
| Provider Information | |||||||||
| NPI: | 1336139765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIRSCHEIN | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | EVAN | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT. 453 PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752625 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066138500 | ||||||||
| FaxNumber: | 7066138844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 05/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 45461 | GA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207K00000X | 045461 | GA | N | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 000797299F | 05 | GA | MEDICAID | 000797299E | 05 | GA | MEDICAID | 03BDBQZ | 01 | GA | MEDICARE PTAN | OTHER |