Provider Demographics
NPI:1104147081
Name:DEEPTI BHASIN MD INC
Entity type:Organization
Organization Name:DEEPTI BHASIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BHASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-333-3058
Mailing Address - Street 1:402 OSIGIAN BLVD
Mailing Address - Street 2:SUTIE 400
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8988
Mailing Address - Country:US
Mailing Address - Phone:478-333-3058
Mailing Address - Fax:478-333-3496
Practice Address - Street 1:402 OSIGIAN BLVD
Practice Address - Street 2:SUTIE 400
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8988
Practice Address - Country:US
Practice Address - Phone:478-333-3058
Practice Address - Fax:478-333-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA408444500AMedicaid