MEDICARE: DR. GEORGE T ASTIN MD

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	207Q00000X	Family Medicine Physician	26439	GA
2	207Q00000X	Family Medicine Physician	00011651	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00011651	OTHER	AL	STATE LICENSE
2	26439	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1730292939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE T ASTIN MD

Provider Business Mailing Address
First Line	:	953 MAPLE ST
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3657
Country	:	US
Telephone Number	:	770-836-9062
Fax Number	:	770-836-9076

Provider Business Practice Location Address
First Line	:	953 MAPLE ST
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3657
Country	:	US
Telephone Number	:	770-836-9062
Fax Number	:	770-836-9076

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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