Healthcare Provider Details

I. General information

NPI: 1073582748
Provider Name (Legal Business Name): LADONNA DICHELLE GEORGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N MAIN ST
WARREN AR
71671-2719
US

IV. Provider business mailing address

302 N MAIN ST
WARREN AR
71671-2719
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-2112
  • Fax: 870-226-2987
Mailing address:
  • Phone: 870-226-2112
  • Fax: 870-226-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE1823
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: