Healthcare Provider Details

I. General information

NPI: 1588590830
Provider Name (Legal Business Name): AMELIA MCGEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BRIDGE STREET, EAST JORDAN, MI, USA 1863
EAST JORDAN MI
49727
US

IV. Provider business mailing address

601 BRIDGE STREET, EAST JORDAN, MI, USA
EAST JORDAN MI
49727-9421
US

V. Phone/Fax

Practice location:
  • Phone: 231-497-4605
  • Fax: 231-497-4605
Mailing address:
  • Phone: 231-536-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number183736652
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: