Provider Demographics
NPI:1588219638
Name:HOUSE, GEORGIA ANN
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:ANN
Last Name:HOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3692
Mailing Address - Country:US
Mailing Address - Phone:770-773-5946
Mailing Address - Fax:
Practice Address - Street 1:110 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3692
Practice Address - Country:US
Practice Address - Phone:770-773-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician