Provider Demographics
NPI:1285717942
Name:BHASIN, DEEPTI JAIN (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPTI
Middle Name:JAIN
Last Name:BHASIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEEPTI
Other - Middle Name:JAIN
Other - Last Name:BHASIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC281662084F0202X
GA0599792084P0804X, 2084F0202X
SCMD281662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1285717942OtherINDIVIDUAL NPI
GA408444500BMedicaid
GA1104147081OtherGROUP NPI
GA408444500BMedicaid