MEDICARE: MR. MANU JACOB 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	207R00000X	Internal Medicine Physician	95408	GA

General Provider Information

NPI Number	:	1548880032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MANU JACOB GEORGE MD

Provider Business Mailing Address
First Line	:	1057 MAIN ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1482
Country	:	US
Telephone Number	:	404-301-4555
Fax Number	:	404-301-4482

Provider Business Practice Location Address
First Line	:	1057 MAIN ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1482
Country	:	US
Telephone Number	:	404-301-4555
Fax Number	:	404-301-4482

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

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	06/14/2023

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