Individual
MR. JOHN STUART DIRKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 B SRP DR, EVANS, GA 30809-3319
(706) 210-8400
(706) 210-8311
Mailing address
104 B SRP DR, EVANS, GA 30809-3319
(706) 210-8400
(706) 210-8311
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
033771
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260048595
RAILROAD MEDICARE
GA
Enumeration date
06/30/2005
Last updated
10/03/2012
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