MEDICARE: SHARON JYOTI GEORGE 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	97391	GA

General Provider Information

NPI Number	:	1447870951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON JYOTI GEORGE MD

Provider Business Mailing Address
First Line	:	1462 MONTREAL RD STE 316
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-6924
Country	:	US
Telephone Number	:	678-559-9758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1462 MONTREAL RD STE 316
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-6924
Country	:	US
Telephone Number	:	678-559-9758
Fax Number	:

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

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	10/08/2023

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