Provider Demographics
NPI:1669486585
Name:GEORGE I. KURITA JR MD PC
Entity Type:Organization
Organization Name:GEORGE I. KURITA JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:I
Authorized Official - Last Name:KURITA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:931-552-1352
Mailing Address - Street 1:PO BOX 3882
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-0882
Mailing Address - Country:US
Mailing Address - Phone:931-552-1352
Mailing Address - Fax:931-551-8226
Practice Address - Street 1:1812 HAYNES ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4547
Practice Address - Country:US
Practice Address - Phone:931-552-1352
Practice Address - Fax:931-551-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
TN3166020Medicare PIN