Provider Demographics
NPI:1114028123
Name:SCONTSAS, GEORGE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOHN
Last Name:SCONTSAS
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 1:1201 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7306
Mailing Address - Country:US
Mailing Address - Phone:910-254-1414
Mailing Address - Fax:910-254-1266
Practice Address - Street 1:1201 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7306
Practice Address - Country:US
Practice Address - Phone:910-254-1414
Practice Address - Fax:910-254-1266
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC328522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA27647Medicare UPIN