Provider Demographics
NPI:1891176491
Name:GEORGE, MARK A (FNP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GEORGE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HAMILTON CT
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3066
Mailing Address - Country:US
Mailing Address - Phone:864-477-0204
Mailing Address - Fax:
Practice Address - Street 1:107 HAMILTON CT
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3066
Practice Address - Country:US
Practice Address - Phone:864-477-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF0515447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily