MEDICARE: GEORGE M. SANDOZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	20125	SC
2	207W00000X	Ophthalmology Physician	20125	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5417704	OTHER	SC	HEALTHSOURCE/CIGNA
2	540600	OTHER	SC	FOCUS
3	5960633	OTHER	SC	AETNA OPEN NETWORK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1180501	OTHER	SC	FIRST HEALTH
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	81449	OTHER	SC	MEDCOST
8	434038	OTHER	SC	ONE HEALTH PLAN
9	2084681	OTHER	SC	AETNA HMO NETWORK
10	5787266001	OTHER	SC	CIGNA
11	0504373	OTHER	SC	PHYSICIANS HEALTH PLAN
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013975010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE M. SANDOZ MD

Provider Business Mailing Address
First Line	:	300 SINGLETON RIDGE RD
Second Line	:	ATTENTION PATIENT ACCOUNTING
City	:	CONWAY
State	:	SC
Zip	:	29526-9142
Country	:	US
Telephone Number	:	843-234-8950
Fax Number	:	843-234-6990

Provider Business Practice Location Address
First Line	:	8024 MYRTLE TRACE DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-8945
Country	:	US
Telephone Number	:	843-234-8950
Fax Number	:	843-234-8951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	11/25/2020

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