Dirksen, John Stuart

Dirksen, John Stuart is an sole proprietor health care provider with primary practice located at 104 B Srp Dr , Evans GA 30809-3319. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Dirksen, John Stuart can be contacted via phone (706) 210-8400.

Contact Information

Primary practice address
104 B Srp Dr Evans GA 30809-3319
Fax: (706) 210-8311
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 033771 Georgia

Profile Details

NPI number 1679570147
LBN Legal business name Dirksen, John Stuart
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 30th, 2005
Last updated Oct 3rd, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679570147 NPPES
Georgia Other 260048595 RAILROAD MEDICARE

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