Provider Demographics
NPI:1144428244
Name:DAVID L GEORGE, M.D.,P.C.
Entity Type:Organization
Organization Name:DAVID L GEORGE, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-767-7829
Mailing Address - Street 1:6025 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2131
Mailing Address - Country:US
Mailing Address - Phone:901-767-7829
Mailing Address - Fax:901-767-0844
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-767-7829
Practice Address - Fax:901-767-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN20127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3060320Medicaid
TN3060320Medicaid