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General NPI Number Information
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NPI Number | 1386249969
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Entity Type | Individual
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Provider Name | KRISTIN MICHELLE GEORGE
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Gender | Female
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 3099 BUCHANAN RD SE APT 212
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City | CLEVELAND
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State | TN
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Zip | 37323-3120
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Country | US
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Telephone | 904-330-7479
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Fax |
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Provider Business Mailing Address
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Address Line | 3099 BUCHANAN RD SE APT 212
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City | CLEVELAND
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State | TN
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Zip | 37323-3120
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Country | US
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Telephone | 423-284-8462
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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 | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number | 0120517
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License Number State | TN
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