Provider Demographics
NPI:1407832348
Name:BISHOP, GEORGE BLAINE JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:BLAINE
Last Name:BISHOP
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY STE 400
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3404
Mailing Address - Country:US
Mailing Address - Phone:205-595-8985
Mailing Address - Fax:205-595-8987
Practice Address - Street 1:3686 GRANDVIEW PKWY STE 400
Practice Address - Street 2:SUITE 600
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3404
Practice Address - Country:US
Practice Address - Phone:205-595-8985
Practice Address - Fax:205-595-8987
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL13093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E89788Medicare UPIN
AL89084Medicare PIN