Provider Demographics
NPI:1922021179
Name:GEORGE, JESSIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 ALLIANCE BLVD.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5368
Mailing Address - Country:US
Mailing Address - Phone:469-467-0011
Mailing Address - Fax:469-467-4923
Practice Address - Street 1:4708 ALLIANCE BLVD.
Practice Address - Street 2:SUITE 600
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5368
Practice Address - Country:US
Practice Address - Phone:469-467-0011
Practice Address - Fax:469-467-4923
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1110207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173609204Medicaid
TX173609205Medicaid
TX8L25878Medicare PIN
TX173609204Medicaid