Provider Demographics
NPI:1437526340
Name:DEVITA, GEORGE A
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:DEVITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27082 WADDINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3277
Mailing Address - Country:US
Mailing Address - Phone:315-783-5876
Mailing Address - Fax:
Practice Address - Street 1:23D MEDICAL GROUP 3278 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699-1793
Practice Address - Country:US
Practice Address - Phone:315-783-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical