Provider Demographics
NPI:1306615141
Name:DEAS, JIMAL ROMANE
Entity type:Individual
Prefix:
First Name:JIMAL
Middle Name:ROMANE
Last Name:DEAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SUMMIT FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-6071
Mailing Address - Country:US
Mailing Address - Phone:803-316-8655
Mailing Address - Fax:
Practice Address - Street 1:3075 JONQUIL DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3719
Practice Address - Country:US
Practice Address - Phone:803-720-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS.62632083S0010X
GAMT0097262083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine