Provider Demographics
NPI:1275822314
Name:GEORGE R MCWHORTER, M.D., PC
Entity Type:Organization
Organization Name:GEORGE R MCWHORTER, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-788-2242
Mailing Address - Street 1:401 TUSCALOOSA AVE SW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1416
Mailing Address - Country:US
Mailing Address - Phone:205-788-2242
Mailing Address - Fax:205-788-7324
Practice Address - Street 1:401 TUSCALOOSA AVE SW
Practice Address - Street 2:SUITE 220
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1416
Practice Address - Country:US
Practice Address - Phone:205-788-2242
Practice Address - Fax:205-788-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8979207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000015063Medicaid
AL000015063Medicaid