Provider Demographics
NPI:1306819628
Name:PROFFITT, GEORGE W (NP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:PROFFITT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W POYTHRESS ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2532
Mailing Address - Country:US
Mailing Address - Phone:804-458-8557
Mailing Address - Fax:804-541-7113
Practice Address - Street 1:815 W POYTHRESS ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2532
Practice Address - Country:US
Practice Address - Phone:804-458-8557
Practice Address - Fax:804-541-7113
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166588363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ56258Medicare UPIN
VAVV13499844Medicare PIN
VA008998D92Medicare PIN