Provider Demographics
NPI:1073916144
Name:MOUZONG, GEORGES
Entity Type:Individual
Prefix:
First Name:GEORGES
Middle Name:
Last Name:MOUZONG
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 1:10095 WASHINGTON BLVD N APT 221
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1947
Mailing Address - Country:US
Mailing Address - Phone:202-830-9608
Mailing Address - Fax:
Practice Address - Street 1:10095 WASHINGTON BLVD N APT 221
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1947
Practice Address - Country:US
Practice Address - Phone:202-830-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006312164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse