Provider Demographics
NPI:1255331674
Name:PERDUE, GEORGE KEVIN (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:KEVIN
Last Name:PERDUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:G
Other - Middle Name:KEVIN
Other - Last Name:PERDUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:100 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3179
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:1240 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-506-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0502442081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000911061EMedicaid
GA000911061FMedicaid
GAP00072861OtherRAILROAD MEDICARE
H42587Medicare UPIN
GA000911061FMedicaid