Healthcare Provider Details

I. General information

NPI: 1538219399
Provider Name (Legal Business Name): GEORGE LESTER TARBUTTON MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JEFFERSON ST
LAUREL MS
39440-4243
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-2273
  • Fax: 601-426-9637
Mailing address:
  • Phone: 601-425-7550
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number18901
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: