Provider Demographics
NPI:1508919366
Name:MADRAY, GEORGE WILLIAM JR (DMDP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:MADRAY
Suffix:JR
Gender:M
Credentials:DMDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CARTERET RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-3028
Mailing Address - Country:US
Mailing Address - Phone:912-264-2155
Mailing Address - Fax:912-261-0392
Practice Address - Street 1:124 CARTERET RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-3028
Practice Address - Country:US
Practice Address - Phone:912-264-2155
Practice Address - Fax:912-261-0392
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0087841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice