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General NPI Number Information
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NPI Number | 1134387251
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Entity Type | Individual
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Provider Name | GEORGE D SHOUP MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 503 BLUEBIRD BLVD POST OFFICE BOX 1466
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City | FORT VALLEY
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State | GA
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Zip | 31030-5083
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Country | US
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Telephone | 478-825-8954
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Fax |
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Provider Business Mailing Address
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Address Line | 503 BLUE BIRD BOULEVARD POST OFFICE BOX 1466
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City | FORT VALLEY
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State | GA
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Zip | 31030
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Country | US
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Telephone | 478-825-8954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28214
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License Number State | GA
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