Provider Demographics
NPI:1043940729
Name:FAWCETT, GEORGE ERNEST
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ERNEST
Last Name:FAWCETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:METLAKATLA
Mailing Address - State:AK
Mailing Address - Zip Code:99926-0008
Mailing Address - Country:US
Mailing Address - Phone:907-886-6911
Mailing Address - Fax:907-886-6917
Practice Address - Street 1:1271 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:METLAKATLA
Practice Address - State:AK
Practice Address - Zip Code:99926
Practice Address - Country:US
Practice Address - Phone:907-886-6911
Practice Address - Fax:907-886-6917
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker