Healthcare Provider Details

I. General information

NPI: 1114694528
Provider Name (Legal Business Name): YVONNE GEORGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5544 KAREN ELAINE DR
NEW CARROLLTON MD
20784-4108
US

IV. Provider business mailing address

5544 KAREN ELAINE DR
NEW CARROLLTON MD
20784-4108
US

V. Phone/Fax

Practice location:
  • Phone: 240-779-5411
  • Fax: 410-946-2010
Mailing address:
  • Phone: 240-779-5411
  • Fax: 410-946-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00189942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: