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NPI Code Detail

MEDICARE: MR. GEORGE JASON CLEVENGER PA-C

MEDICARE: MR. GEORGE JASON CLEVENGER PA-C
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
1363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1871554931
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE JASON CLEVENGER PA-C
Provider Business Mailing Address
First Line : 146 WILLIAMS DR
Second Line :
City : SPENCER
State : WV
Zip : 25276-1826
Country : US
Telephone Number : 304-927-1495
Fax Number :
Provider Business Practice Location Address
First Line : 146 WILLIAMS DR
Second Line :
City : SPENCER
State : WV
Zip : 25276-1826
Country : US
Telephone Number : 304-927-1495
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 03/17/2015

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Directions to “ MR. GEORGE JASON CLEVENGER PA-C” Practice Location

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