Healthcare Provider Details

I. General information

NPI: 1821081548
Provider Name (Legal Business Name): GEORGE THOMAS SPROUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 COMMUNITY DR
WAYNESBORO VA
22980-9505
US

IV. Provider business mailing address

19 GREEN HILLS DRIVE
VERONA VA
24482-2659
US

V. Phone/Fax

Practice location:
  • Phone: 540-949-0118
  • Fax: 540-949-8903
Mailing address:
  • Phone: 540-949-0118
  • Fax: 540-932-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101028473
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: