Organization
JAMES R. DEATHERAGE D.M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BECKY JANE BARROW (OFFICE MANAGER)
(251) 867-6837
Entity
Organization
Contact information
Practice address
422 DOUGLAS AVE, BREWTON, AL 36426-2052
(251) 867-6837
(251) 867-6278
Mailing address
422 DOUGLAS AVE, BREWTON, AL 36426-2052
(251) 867-6837
(251) 867-6278
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4913
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113806
—
AL
01
—
510-67264
BLUE CROSS & BLUE SHIELD
AL
01
—
996355
UNITED CONCORDIA
PA
Enumeration date
03/29/2010
Last updated
03/29/2010
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