Provider Demographics
NPI:1821081548
Name:SPROUL, GEORGE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:THOMAS
Last Name:SPROUL
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 1:19 GREEN HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2659
Mailing Address - Country:US
Mailing Address - Phone:540-949-0118
Mailing Address - Fax:540-932-2059
Practice Address - Street 1:108 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9505
Practice Address - Country:US
Practice Address - Phone:540-949-0118
Practice Address - Fax:540-949-8903
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010284732080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6736718Medicaid
VA6736718OtherVA PREMIER
VA245894OtherANTHEM
VA45630OtherSENTARA
VA200370OtherSOUTHERN HEALTH
VA6736718Medicaid