Provider Demographics
NPI:1902862519
Name:GEORGE, WILBURN EDWIN JR (MD)
Entity Type:Individual
Prefix:
First Name:WILBURN
Middle Name:EDWIN
Last Name:GEORGE
Suffix:JR
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-393-7831
Mailing Address - Fax:931-393-7833
Practice Address - Street 1:1801 NORTH JACKSON STREET
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-393-7831
Practice Address - Fax:931-393-7833
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10360207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN58479OtherBLUECROSS
TN3014316Medicaid
TN3014373Medicare ID - Type Unspecified
TN58479OtherBLUECROSS