Provider Demographics
NPI:1629713391
Name:GEORGE, EDDIE CHARLES JR
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:CHARLES
Last Name:GEORGE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 CIRCLE BROOK DR APT F
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8241
Mailing Address - Country:US
Mailing Address - Phone:540-553-6555
Mailing Address - Fax:
Practice Address - Street 1:3317 CIRCLE BROOK DR APT F
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8241
Practice Address - Country:US
Practice Address - Phone:540-553-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program