Provider Demographics
NPI:1952488603
Name:MOLSON, GEORGE (CRNA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MOLSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 MILL STATION PLACE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257
Mailing Address - Country:US
Mailing Address - Phone:229-353-6208
Mailing Address - Fax:229-353-7722
Practice Address - Street 1:4652 MILL STATION PLACE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:229-353-6208
Practice Address - Fax:229-353-7722
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28182249A367500000X
GARN080513367500000X
LAAP04439367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014249Medicaid
IN200936900Medicaid
GAP00413422OtherRAILROAD MEDICARE
AL009943111Medicaid
IN000000610491OtherANTHEM PROVIDER NUMBER
GA475163752AMedicaid
IN200936900Medicaid
LA3A256CQ68Medicare PIN
AL009943111Medicaid