MEDICARE: ELIZABETH GEORGE M.D

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	207Q00000X	Family Medicine Physician	055222	GA

General Provider Information

NPI Number	:	1336132703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GEORGE M.D

Provider Business Mailing Address
First Line	:	4370 DUNMORE RD NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-4221
Country	:	US
Telephone Number	:	770-579-0425
Fax Number	:	770-579-0425

Provider Business Practice Location Address
First Line	:	207 RIVER PARK NORTH DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-7835
Country	:	US
Telephone Number	:	770-516-3001
Fax Number	:	770-579-0425

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	12/15/2011

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