MEDICARE: MS. VONDA S GEORGE

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	247200000X	Other Technician	0230003013	VA

General Provider Information

NPI Number	:	1144611351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VONDA S GEORGE

Provider Business Mailing Address
First Line	:	5366 PALMYRA CT
Second Line	:
City	:	VA BEACH
State	:	VA
Zip	:	23462-3543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5366 PALMYRA CT
Second Line	:
City	:	VA BEACH
State	:	VA
Zip	:	23462-3543
Country	:	US
Telephone Number	:	757-803-2994
Fax Number	:

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

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/10/2015

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