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General NPI Number Information
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NPI Number | 1144944521
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Entity Type | Organization
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Legal Business Name | ST GEORGE HEALING HANDS LLC
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 9616 DEER VALLEY DR
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City | TALLAHASSEE
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State | FL
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Zip | 32312-4245
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Country | US
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Telephone | 219-662-3931
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Fax | 219-663-6359
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Provider Business Mailing Address
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Address Line | 9616 DEER VALLEY DR
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City | TALLAHASSEE
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State | FL
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Zip | 32312-4245
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Country | US
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Telephone | 219-662-3931
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Fax | 219-663-6359
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Authorized Official
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Title or Position | OWNER
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Name | BASIM TADROS
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Credential | MD
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Telephone | 850-319-7444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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