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General NPI Number Information
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NPI Number | 1245495142
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Entity Type | Organization
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Legal Business Name | GEORGE R SMALL JR MD PC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 284 N MADISON AVE
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City | GREENWOOD
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State | IN
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Zip | 46142-3634
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Country | US
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Telephone | 317-888-7745
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Fax |
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Provider Business Mailing Address
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Address Line | 284 N MADISON AVE
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City | GREENWOOD
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State | IN
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Zip | 46142-3634
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Country | US
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Telephone | 317-888-7745
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. GEORGE R SMALL, JR
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Credential | MD
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Telephone | 317-422-5490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 01022870A
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License Number State | IN
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