MEDICARE: DR. EON GEORGE PHD, EDD, EDS, NCC

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	101YP2500X	Professional Counselor	347612	GA
2	101Y00000X	Counselor
3	101YM0800X	Mental Health Counselor
4	101YP1600X	Pastoral Counselor
5	101YS0200X	School Counselor	1379346	GA

General Provider Information

NPI Number	:	1619266970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EON GEORGE PHD, EDD, EDS, NCC

Provider Business Mailing Address
First Line	:	354 KENTWOOD SPRINGS DR
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-5937
Country	:	US
Telephone Number	:	678-670-6496
Fax Number	:	678-759-1552

Provider Business Practice Location Address
First Line	:	354 KENTWOOD SPRINGS DR
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-5937
Country	:	US
Telephone Number	:	678-670-6496
Fax Number	:	678-759-1552

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	02/12/2025

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