Provider Demographics
NPI:1912008384
Name:TATE, GEORGE WHALEY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WHALEY
Last Name:TATE
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 1:6300 E INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-6944
Mailing Address - Country:US
Mailing Address - Phone:704-535-0925
Mailing Address - Fax:704-537-0204
Practice Address - Street 1:6300 E INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6944
Practice Address - Country:US
Practice Address - Phone:704-535-0925
Practice Address - Fax:704-537-0204
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22184207W00000X
SC13326207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131JPMedicaid
NC89131JPMedicaid
NC210858KMedicare ID - Type Unspecified