Provider Demographics
NPI:1730292939
Name:ASTIN, GEORGE T (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:ASTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:953 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3657
Mailing Address - Country:US
Mailing Address - Phone:770-836-9062
Mailing Address - Fax:770-836-9076
Practice Address - Street 1:953 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3657
Practice Address - Country:US
Practice Address - Phone:770-836-9062
Practice Address - Fax:770-836-9076
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26439207Q00000X
AL00011651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00011651OtherSTATE LICENSE
GA26439OtherSTATE LICENSE
GA26439OtherSTATE LICENSE
GAC71950Medicare UPIN