Healthcare Provider Details

I. General information

NPI: 1619060415
Provider Name (Legal Business Name): RAVINDRA K GEORGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 202
SAVANNAH GA
31405-6009
US

IV. Provider business mailing address

PO BOX 919
RINCON GA
31326-0919
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-0920
  • Fax:
Mailing address:
  • Phone: 912-826-4057
  • Fax: 912-826-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036116875
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number45470
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: