Provider Demographics
NPI:1609569995
Name:GEORGE, LYDIA MARIAM (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIAM
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTHEAST HEALTH INTERNAL MEDICINE RESIDENCY PROGRAM
Mailing Address - Street 2:1108 ROSS CLARK CIRCLE, SUITE 210
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302
Mailing Address - Country:US
Mailing Address - Phone:334-712-3329
Mailing Address - Fax:
Practice Address - Street 1:SOUTHEAST HEALTH INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - Street 2:1108 ROSS CLARK CIRCLE, SUITE 210
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36302
Practice Address - Country:US
Practice Address - Phone:334-712-3329
Practice Address - Fax:334-305-0219
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program