MEDICARE: BETTY JEAN GEORGE BS, INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC016254	GA
2	101YM0800X	Mental Health Counselor	LPC016254	GA

General Provider Information

NPI Number	:	1174963342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY JEAN GEORGE BS, INTERN

Provider Business Mailing Address
First Line	:	935 OLD ROCKY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8477
Country	:	US
Telephone Number	:	478-978-6979
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 OLD ROCKY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8477
Country	:	US
Telephone Number	:	478-978-6979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	01/14/2026

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