Healthcare Provider Details

I. General information

NPI: 1811130123
Provider Name (Legal Business Name): DIANE TERESA GEORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 EDGEWATER CORPORATE PKWY STE 106
FORT MILL SC
29707-4526
US

IV. Provider business mailing address

1040 EDGEWATER CORPORATE PKWY STE 106
FORT MILL SC
29707-4526
US

V. Phone/Fax

Practice location:
  • Phone: 803-913-4500
  • Fax: 803-913-4600
Mailing address:
  • Phone: 803-913-4500
  • Fax: 803-913-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012-00850
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number91931
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2012-00850
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: