Healthcare Provider Details

I. General information

NPI: 1083243174
Provider Name (Legal Business Name): JULIAN THOMAS GEORGE DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GAVOTTE LN
ANDERSON SC
29621-8205
US

IV. Provider business mailing address

100 GAVOTTE LN
ANDERSON SC
29621-8205
US

V. Phone/Fax

Practice location:
  • Phone: 864-261-7474
  • Fax:
Mailing address:
  • Phone: 864-261-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number23282
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: