Healthcare Provider Details

I. General information

NPI: 1518915552
Provider Name (Legal Business Name): GEORGE GARLAND BIRDSONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE GRADY MEMORIAL HOSPITAL, RM. CG35
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

80 JESSE HILL JR. DR., RM. CG35 GRADY MEMORIAL HOSPITAL
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-3164
  • Fax: 404-616-9084
Mailing address:
  • Phone: 404-616-3164
  • Fax: 404-616-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number029410
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number029410
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: