MEDICARE: GEORGE I. KURITA JR 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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1669486585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE I. KURITA JR MD PC

Provider Business Mailing Address
First Line	:	PO BOX 3882
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-0882
Country	:	US
Telephone Number	:	931-552-1352
Fax Number	:	931-551-8226

Provider Business Practice Location Address
First Line	:	1812 HAYNES ST
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4547
Country	:	US
Telephone Number	:	931-552-1352
Fax Number	:	931-551-8226

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEORGE I KURITA JR.
Credential	:	MD
Telephone Number	:	931-552-1352

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	04/20/2008

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