Provider Demographics
NPI:1639465073
Name:DORTON, GEORGE III
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:DORTON
Suffix:III
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 1:12100 FAIRWAY OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6607
Mailing Address - Country:US
Mailing Address - Phone:678-522-9124
Mailing Address - Fax:
Practice Address - Street 1:12100 FAIRWAY OVERLOOK
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-6607
Practice Address - Country:US
Practice Address - Phone:678-522-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor