Provider Demographics
NPI:1508596743
Name:GEORGE, JEFFERY L
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:L
Last Name:GEORGE
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 1:832 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-9739
Mailing Address - Country:US
Mailing Address - Phone:172-741-7663
Mailing Address - Fax:
Practice Address - Street 1:832 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-9739
Practice Address - Country:US
Practice Address - Phone:727-417-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker