Healthcare Provider Details

I. General information

NPI: 1164647772
Provider Name (Legal Business Name): GEORGE A SITARAS OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

4870 LEEDS CT
SUWANEE GA
30024-1361
US

V. Phone/Fax

Practice location:
  • Phone: 770-533-8204
  • Fax: 770-531-3862
Mailing address:
  • Phone: 770-887-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT004317
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: