MEDICARE: KRISTIN MICHELLE 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	347E00000X	Transportation Broker	0120517	TN

General Provider Information

NPI Number	:	1386249969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MICHELLE GEORGE

Provider Business Mailing Address
First Line	:	3099 BUCHANAN RD SE APT 212
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-3120
Country	:	US
Telephone Number	:	423-284-8462
Fax Number	:

Provider Business Practice Location Address
First Line	:	3099 BUCHANAN RD SE APT 212
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-3120
Country	:	US
Telephone Number	:	904-330-7479
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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