Provider Demographics
NPI:1568489110
Name:DRUMHELLER, GEORGIA A (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:A
Last Name:DRUMHELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:A
Other - Last Name:HENNESSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1141 N ROAD ST
Mailing Address - Street 2:STE M
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-449-7373
Mailing Address - Fax:252-449-7371
Practice Address - Street 1:4810 S CROATAN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959
Practice Address - Country:US
Practice Address - Phone:252-449-7373
Practice Address - Fax:252-449-7371
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500382208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43427Medicare UPIN