Provider Demographics
NPI:1962494922
Name:FARRELL, GEORGE J III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:FARRELL
Suffix:III
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:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0289
Mailing Address - Country:US
Mailing Address - Phone:276-244-1557
Mailing Address - Fax:276-524-2710
Practice Address - Street 1:1107 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614
Practice Address - Country:US
Practice Address - Phone:276-244-1557
Practice Address - Fax:276-524-2710
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221504207Y00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962494922Medicaid
VA308465OtherANTHEM (BCBS)
VA015816W60Medicare PIN
VA308465OtherANTHEM (BCBS)