Provider Demographics
NPI:1093804817
Name:SICH, GEORGE III (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:SICH
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 15TH ST STE BI1056
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-446-5941
Mailing Address - Fax:706-721-9286
Practice Address - Street 1:901 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803
Practice Address - Country:US
Practice Address - Phone:803-648-6988
Practice Address - Fax:803-648-6984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC569213ES0131X
GAPOD001182213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA04730281Medicare PIN
SCV00166Medicare UPIN
SC5160450001Medicare NSC