Provider Demographics
NPI:1891814877
Name:TETLOW, GEORGIA KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:KATHERINE
Last Name:TETLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 EAGLE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3115
Mailing Address - Country:US
Mailing Address - Phone:888-702-7974
Mailing Address - Fax:888-702-7974
Practice Address - Street 1:200 EAGLE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3115
Practice Address - Country:US
Practice Address - Phone:888-702-7974
Practice Address - Fax:888-702-7974
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432889208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation