Provider Demographics
NPI:1679505630
Name:GEORGE, ADRIENNE PHILOMENA (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:PHILOMENA
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 1:1219 HODGES DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4611
Mailing Address - Country:US
Mailing Address - Phone:850-877-5767
Mailing Address - Fax:850-877-5055
Practice Address - Street 1:1219 HODGES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4611
Practice Address - Country:US
Practice Address - Phone:850-877-5767
Practice Address - Fax:850-877-5055
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64068OtherBCBS
FL271612700Medicaid
FL64068OtherBCBS