Healthcare Provider Details

I. General information

NPI: 1528173812
Provider Name (Legal Business Name): GEORGE J CARLEY DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 HOLLAND AVE
PORT HURON MI
48060-1519
US

IV. Provider business mailing address

1943 HOLLAND AVE
PORT HURON MI
48060-1519
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-5700
  • Fax: 810-985-5454
Mailing address:
  • Phone: 810-985-5700
  • Fax: 810-985-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRS074708
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJB070145
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGC011673
License Number StateMI

VIII. Authorized Official

Name: DR. GEORGE J CARLEY JR.
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 810-985-5700