Provider Demographics
NPI:1932109303
Name:CHILDS, GEORGE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:CHILDS
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 1:250 2ND ST E
Mailing Address - Street 2:SUITE 4F
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1029
Mailing Address - Country:US
Mailing Address - Phone:941-747-8404
Mailing Address - Fax:941-747-0773
Practice Address - Street 1:250 2ND ST E
Practice Address - Street 2:SUITE 4F
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1029
Practice Address - Country:US
Practice Address - Phone:941-747-8404
Practice Address - Fax:941-747-0773
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89270208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271669OtherAMERIGROUP
FL272278000Medicaid
FL37679OtherBCBSFL PROVIDER NUMBER
FL2193121OtherCIGNA
FL373337OtherUNITED HEALTHCARE
FL228678OtherWELLCARE
FL37679Medicare PIN
FL37679OtherBCBSFL PROVIDER NUMBER