Healthcare Provider Details

I. General information

NPI: 1588732804
Provider Name (Legal Business Name): BASIL A GEORGI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 27TH STREET, BRAUNLIN BLDG SUITE 306
PORTSMOUTH OH
45662
US

IV. Provider business mailing address

1711 27TH STREET, BRAUNLIN BUILDING SUITE 306
PORTSMOUTH OH
45662
US

V. Phone/Fax

Practice location:
  • Phone: 740-353-8661
  • Fax: 740-354-3254
Mailing address:
  • Phone: 740-353-8661
  • Fax: 740-354-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOH35070727
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-070727
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: