Provider Demographics
NPI:1578623799
Name:CASSIDY, GEORGE TIMOTHY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:TIMOTHY
Last Name:CASSIDY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:ATTN SLEEP DISORDERS CLINIC
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-2252
Mailing Address - Fax:706-787-6828
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:ATTN CREDENTIALS
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-2720
Practice Address - Fax:706-787-8176
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-07-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD 000Medicare UPIN