Provider Demographics
NPI:1548418452
Name:FRED GEORGE PH.D,, P.A.
Entity Type:Organization
Organization Name:FRED GEORGE PH.D,, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-347-1862
Mailing Address - Street 1:1275 JAMES DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2063
Mailing Address - Country:US
Mailing Address - Phone:334-347-1862
Mailing Address - Fax:334-347-2919
Practice Address - Street 1:1275 JAMES DR
Practice Address - Street 2:SUITE A
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2063
Practice Address - Country:US
Practice Address - Phone:334-347-1862
Practice Address - Fax:334-347-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL143251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890001970Medicaid