Provider Demographics
NPI:1710934559
Name:FANT, GEORGE ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ERNEST
Last Name:FANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5395
Mailing Address - Country:US
Mailing Address - Phone:256-546-5281
Mailing Address - Fax:
Practice Address - Street 1:1521 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5395
Practice Address - Country:US
Practice Address - Phone:256-546-5281
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13920207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE54739Medicare UPIN