Provider Demographics
NPI:1508004433
Name:BIRD, GEORGE MACK III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MACK
Last Name:BIRD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:821 PLAZA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023
Mailing Address - Country:US
Mailing Address - Phone:478-374-9935
Mailing Address - Fax:478-374-7442
Practice Address - Street 1:821 PLAZA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023
Practice Address - Country:US
Practice Address - Phone:478-374-9935
Practice Address - Fax:478-374-7442
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035-210207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000502312AMedicaid
GA000502312AMedicaid