Healthcare Provider Details

I. General information

NPI: 1124205562
Provider Name (Legal Business Name): GEORGE A ORDWAY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ENOTA DR NE SUITE 200
GAINESVILLE GA
30501-3473
US

IV. Provider business mailing address

200 S ENOTA DR NE SUITE 200
GAINESVILLE GA
30501-3473
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-2020
  • Fax: 770-534-8025
Mailing address:
  • Phone: 770-534-2020
  • Fax: 770-534-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005241
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: