Provider Demographics
NPI:1558553727
Name:DR GEORGE T MATHAI PLLC
Entity Type:Organization
Organization Name:DR GEORGE T MATHAI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOTTAKARA
Authorized Official - Last Name:MATHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-535-3734
Mailing Address - Street 1:224 LONG ST
Mailing Address - Street 2:
Mailing Address - City:NEW JOHNSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37134-2468
Mailing Address - Country:US
Mailing Address - Phone:931-535-3734
Mailing Address - Fax:931-535-3742
Practice Address - Street 1:224 LONG ST
Practice Address - Street 2:
Practice Address - City:NEW JOHNSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37134-2468
Practice Address - Country:US
Practice Address - Phone:931-535-3734
Practice Address - Fax:931-535-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3889576Medicaid
TN3889576Medicaid