MEDICARE: GEORGE GEORGES 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0101259884	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06115	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1700173481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE GEORGES MD

Provider Business Mailing Address
First Line	:	8266 ATLEE RD
Second Line	:	SUITE 332
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-1804
Country	:	US
Telephone Number	:	804-764-7686
Fax Number	:	804-764-7689

Provider Business Practice Location Address
First Line	:	3420 PUMP RD # 113
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233
Country	:	US
Telephone Number	:	804-223-2404
Fax Number	:

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	08/17/2021

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