MEDICARE: DR. GEORGE JOSEPH VELLANIKARAN 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	207RC0000X	Cardiovascular Disease Physician	033219	GA

General Provider Information

NPI Number	:	1083619233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE JOSEPH VELLANIKARAN MD

Provider Business Mailing Address
First Line	:	20 FRANCIS WAY
Second Line	:	SUITE 101
City	:	SHARPSBURG
State	:	GA
Zip	:	30277
Country	:	US
Telephone Number	:	770-253-0611
Fax Number	:	770-502-0521

Provider Business Practice Location Address
First Line	:	20 FRANCIS WAY
Second Line	:	SUITE 101
City	:	SHARPSBURG
State	:	GA
Zip	:	30277
Country	:	US
Telephone Number	:	770-253-0611
Fax Number	:	770-502-0521

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/09/2015

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