Provider Demographics
NPI:1093758724
Name:PURSLEY, GEORGE CLARK (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:CLARK
Last Name:PURSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2360
Mailing Address - Country:US
Mailing Address - Phone:706-726-8727
Mailing Address - Fax:706-426-0384
Practice Address - Street 1:3736 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2360
Practice Address - Country:US
Practice Address - Phone:706-726-8727
Practice Address - Fax:706-426-0384
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031308207P00000X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00391399BMedicaid
GA00391399QMedicaid
GA93BBJRXMedicare ID - Type Unspecified
GA11BDLFNMedicare ID - Type Unspecified
GA00391399QMedicaid
GAE16161Medicare UPIN