Provider Demographics
NPI:1376968560
Name:GEORGE, MARK ALLYN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLYN
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALLYN
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1205 HART RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-3834
Mailing Address - Country:US
Mailing Address - Phone:614-556-1422
Mailing Address - Fax:
Practice Address - Street 1:1205 HART RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3834
Practice Address - Country:US
Practice Address - Phone:614-556-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide