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General NPI Number Information
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NPI Number | 1588743868
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Entity Type | Individual
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Provider Name | ACHENKUNJU K GEORGE M.D., F.A.C.C., F.C.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1115 ALASKA ST STE 114
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City | WEST PLAINS
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State | MO
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Zip | 65775-2000
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Country | US
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Telephone | 417-257-5950
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Fax | 417-257-5924
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Provider Business Mailing Address
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Address Line | PO BOX 1100
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City | WEST PLAINS
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State | MO
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Zip | 65775-1100
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Country | US
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Telephone | 417-257-5950
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Fax | 417-257-5924
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD106574
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License Number State | MO
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