MEDICARE: ELIZABETH GEORGE, MD, PC

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		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2283324-YF	OTHER	GA	STATE ID NUMBER

General Provider Information

NPI Number	:	1528107638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH GEORGE, MD, PC

Provider Business Mailing Address
First Line	:	207 RIVER PARK NORTH DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-7835
Country	:	US
Telephone Number	:	678-388-2184
Fax Number	:	678-388-2188

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	:	678-388-2184
Fax Number	:	678-388-2188

Authorized Official
Title or Position	:	PRESIDENT OWNER PHYSICIAN
Name	:	DR. ELIZABETH CHACKO GEORGE
Credential	:	M.D
Telephone Number	:	678-388-2184

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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