Healthcare Provider Details

I. General information

NPI: 1336132703
Provider Name (Legal Business Name): ELIZABETH GEORGE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7835
US

IV. Provider business mailing address

4370 DUNMORE RD NE
MARIETTA GA
30068-4221
US

V. Phone/Fax

Practice location:
  • Phone: 770-516-3001
  • Fax: 770-579-0425
Mailing address:
  • Phone: 770-579-0425
  • Fax: 770-579-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number055222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: