Provider Demographics
NPI:1538505029
Name:TATE, GEORGIA E (DVM)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:E
Last Name:TATE
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:E
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DVM
Mailing Address - Street 1:25835 S 154TH ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9712
Mailing Address - Country:US
Mailing Address - Phone:480-802-6904
Mailing Address - Fax:480-802-6896
Practice Address - Street 1:25835 S 154TH ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-9712
Practice Address - Country:US
Practice Address - Phone:480-802-6904
Practice Address - Fax:480-802-6896
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1921174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian