Provider Demographics
NPI:1710303334
Name:ANDRSON, GEORGE (RN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ANDRSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 W ISLEWAY CT
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-8683
Mailing Address - Country:US
Mailing Address - Phone:678-877-1304
Mailing Address - Fax:770-888-8524
Practice Address - Street 1:7110 W ISLEWAY CT
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-8683
Practice Address - Country:US
Practice Address - Phone:678-877-1304
Practice Address - Fax:770-888-8524
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153954163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management