Provider Demographics
NPI:1831310416
Name:OSGOODBY, GEORGE GLENNWOOD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GLENNWOOD
Last Name:OSGOODBY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1592 MARS HILL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4890
Mailing Address - Country:US
Mailing Address - Phone:706-769-9009
Mailing Address - Fax:706-769-9885
Practice Address - Street 1:1592 MARS HILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4890
Practice Address - Country:US
Practice Address - Phone:706-769-9009
Practice Address - Fax:706-769-9885
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00399800111N00000X
GACHIR008665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ751579Medicare ID - Type Unspecified