Healthcare Provider Details

I. General information

NPI: 1528302379
Provider Name (Legal Business Name): BINUMOL GEORGE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BINUMOL MATHEW

II. Dates (important events)

Enumeration Date: 11/17/2012
Last Update Date: 11/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 WINN WAY SUITE A-210
DECATUR GA
30030-1754
US

IV. Provider business mailing address

5154 BOWERS BROOK DR SW
LILBURN GA
30047-5171
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-7033
  • Fax:
Mailing address:
  • Phone: 404-944-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN179444
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: