MEDICARE: DR. GEORGE WILLIAM ALLISON PH.D.

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	103TC0700X	Clinical Psychologist	1216	AZ

General Provider Information

NPI Number	:	1669423109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE WILLIAM ALLISON PH.D.

Provider Business Mailing Address
First Line	:	12630 N 103RD AVE
Second Line	:	SUITE 241
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3423
Country	:	US
Telephone Number	:	623-876-8806
Fax Number	:

Provider Business Practice Location Address
First Line	:	12630 N 103RD AVE
Second Line	:	SUITE 241
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3423
Country	:	US
Telephone Number	:	623-876-8806
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/03/2007

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