Provider Demographics
NPI:1720032618
Name:PRESCOTT, GEORGIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:ANN
Last Name:PRESCOTT
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 1:119 BULIFANTS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5747
Mailing Address - Country:US
Mailing Address - Phone:757-564-7337
Mailing Address - Fax:
Practice Address - Street 1:119 BULIFANTS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5709
Practice Address - Country:US
Practice Address - Phone:757-564-7337
Practice Address - Fax:757-564-3205
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
53853OtherSENTARA/OPTIMA
12-02008OtherUNITED HEALTHCARE
1478323OtherCIGNA
2179104OtherAETNA HMO
8128041OtherMAMSI/MDIPA
010126100OtherVA PREMIERE HEALTH PLAN
54-1778786OtherFIRST HEALTH/MAIL HANDLER
54-1778786OtherPHCS
54-1778786-032OtherTRICARE/CHAMPUS
54-1778786OtherVA HEALTH NETWORK
54-1778786OtherMID ATLANTIC HEALTH SOLUT
VA010126100Medicaid
54-1778786OtherCCN
249648OtherSOUTHERN HEALTH
4207833OtherAETNA
VA153986OtherANTHEM
12-02008OtherUNITED HEALTHCARE