Provider Demographics
NPI:1063498400
Name:BENASHVILI, GEORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:BENASHVILI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13333 NORTHWEST FWY
Mailing Address - Street 2:STE 540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6166
Mailing Address - Country:US
Mailing Address - Phone:706-660-6358
Mailing Address - Fax:
Practice Address - Street 1:710 CENTER ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1527
Practice Address - Country:US
Practice Address - Phone:706-571-1064
Practice Address - Fax:706-571-1986
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2020-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0473962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000883979BMedicaid
G90464Medicare UPIN