Provider Demographics
NPI:1205817467
Name:MCCLUSKEY, GEORGE MILTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MILTON
Last Name:MCCLUSKEY
Suffix:III
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:PO BOX 7217
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7217
Mailing Address - Country:US
Mailing Address - Phone:706-322-2462
Mailing Address - Fax:706-322-2891
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE 101A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-322-2462
Practice Address - Fax:706-322-2891
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30342207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL#009939871Medicaid
AL601-05060OtherBLUE CROSS BLUE SHILED OF ALABAMA
GA00430438IMedicaid
GA20NCCRROtherMEDICARE PTAN
GA000430438Medicaid
GA52255395-006OtherBLUE CROSS BLUE SHIELD OF GEORGIA
GA00430438IMedicaid