Provider Demographics
NPI:1932108933
Name:WORTLEY, GEORGE C (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:WORTLEY
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 1:2252 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-3122
Mailing Address - Country:US
Mailing Address - Phone:540-261-7421
Mailing Address - Fax:540-261-1952
Practice Address - Street 1:2252 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-3122
Practice Address - Country:US
Practice Address - Phone:540-261-7421
Practice Address - Fax:540-261-1952
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01-01624OtherUNITED HEALTHCARE PROVIDE
44990OtherSENTARA/OPTIMA PROVIDER N
56-7043-8OtherVA PREMIER PROVIDER NUMBE
541457983OtherTRICARE PROVIDER NUMBER
56-1408-2OtherVA PREMIER PROVIDER NUMBE
165842OtherSOUTHERN HEALTH PROVIDER
186565OtherANTHEM PROVIDER NUMBER
541457983OtherPCHP PROVIDER NUMBER
VA0056-1408-2Medicaid
VA005670438Medicaid
49611OtherMEDCOST PROVIDER NUMBER
700010624OtherCIGNA PROVIDER NUMBER
186565OtherANTHEM PROVIDER NUMBER
080002849Medicare PIN
49611OtherMEDCOST PROVIDER NUMBER