Provider Demographics
NPI:1477551430
Name:PETRYK, GEORGE S (DC,DACNB,FACFN,FABES)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:PETRYK
Suffix:
Gender:M
Credentials:DC,DACNB,FACFN,FABES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5485 BETHELVIEW RD STE 360-333
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9735
Mailing Address - Country:US
Mailing Address - Phone:239-482-0300
Mailing Address - Fax:239-482-4757
Practice Address - Street 1:5485 BETHELVIEW RD STE 360-333
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9735
Practice Address - Country:US
Practice Address - Phone:239-482-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-07-10
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
FLCH8431111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89172OtherBLUE CROSS BLUE SHIELD FL
FL381801200Medicaid
FLU70967Medicare UPIN
FLK5640Medicare ID - Type UnspecifiedGROUP GTP MANAGEMENT
FL381801200Medicaid