Provider Demographics
NPI:1033102454
Name:ANDERSON, GEORGE EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDGAR
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:775 POPLAR RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8300
Mailing Address - Country:US
Mailing Address - Phone:770-400-4510
Mailing Address - Fax:678-423-2737
Practice Address - Street 1:775 POPLAR RD
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8300
Practice Address - Country:US
Practice Address - Phone:770-400-4510
Practice Address - Fax:678-423-2737
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033263207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBCMQMedicare PIN
TN3046125Medicare PIN