Provider Demographics
NPI:1518915552
Name:BIRDSONG, GEORGE GARLAND (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GARLAND
Last Name:BIRDSONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL JR. DR., RM. CG35
Mailing Address - Street 2:GRADY MEMORIAL HOSPITAL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-616-3164
Mailing Address - Fax:404-616-9084
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:GRADY MEMORIAL HOSPITAL, RM. CG35
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-3164
Practice Address - Fax:404-616-9084
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029410207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE30756Medicare UPIN