Healthcare Provider Details

I. General information

NPI: 1003668971
Provider Name (Legal Business Name): SOPHIA P GEORGES AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 MONTREAL RD STE 411
TUCKER GA
30084-6932
US

IV. Provider business mailing address

2505 HARRISON AVE
PANAMA CITY FL
32405-4464
US

V. Phone/Fax

Practice location:
  • Phone: 850-233-3376
  • Fax: 850-522-8354
Mailing address:
  • Phone: 850-233-3376
  • Fax: 850-522-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN315199
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: