Healthcare Provider Details

I. General information

NPI: 1477488815
Provider Name (Legal Business Name): CONCEPCION M GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONNIE M GEORGE

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 N MERIDIAN AVE APT 104
OKLAHOMA CITY OK
73112-1120
US

IV. Provider business mailing address

6308 N MERIDIAN AVE APT 104
OKLAHOMA CITY OK
73112-1120
US

V. Phone/Fax

Practice location:
  • Phone: 405-978-8887
  • Fax:
Mailing address:
  • Phone: 405-978-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: