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General NPI Number Information
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NPI Number | 1477741494
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Entity Type | Organization
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Legal Business Name | ANDREW GEORGE
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 25 S FOURTH ST
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City | ROLLING FORK
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State | MS
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Zip | 39159-5146
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Country | US
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Telephone | 662-873-0477
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Fax | 662-873-0742
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Provider Business Mailing Address
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Address Line | 25 S FOURTH ST
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City | ROLLING FORK
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State | MS
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Zip | 39159-5146
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Country | US
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Telephone | 662-873-0477
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Fax | 662-873-0742
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW GEORGE
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Credential | MD
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Telephone | 662-873-0477
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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 | 13643
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License Number State | MS
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