Provider Demographics
NPI:1700407509
Name:AXTELL, GEORGE CLIFTON II (RRT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:CLIFTON
Last Name:AXTELL
Suffix:II
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 JOHNSTON WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-483-7760
Mailing Address - Fax:
Practice Address - Street 1:12302 ROARINGBROOK CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-2106
Practice Address - Country:US
Practice Address - Phone:804-350-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1170046822279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DXH7310OtherPERSONAL