Provider Demographics
NPI:1619266970
Name:GEORGE, EON (BA MA, MED, EDS)
Entity Type:Individual
Prefix:
First Name:EON
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:BA MA, MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 KENTWOOD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5937
Mailing Address - Country:US
Mailing Address - Phone:678-670-6496
Mailing Address - Fax:678-759-1552
Practice Address - Street 1:354 KENTWOOD SPRINGS DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-5937
Practice Address - Country:US
Practice Address - Phone:678-670-6496
Practice Address - Fax:678-759-1552
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101Y00000X, 101YP1600X
GA1379346101YS0200X
GA347612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool