Provider Demographics
NPI:1013975010
Name:SANDOZ, GEORGE M (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:SANDOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-8950
Mailing Address - Fax:843-234-6990
Practice Address - Street 1:8024 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8945
Practice Address - Country:US
Practice Address - Phone:843-234-8950
Practice Address - Fax:843-234-8951
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC201252084N0400X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5417704OtherHEALTHSOURCE/CIGNA
SC540600OtherFOCUS
SC5960633OtherAETNA OPEN NETWORK
NC7906039Medicaid
SC1180501OtherFIRST HEALTH
PA01839335Medicaid
SC81449OtherMEDCOST
SC434038OtherONE HEALTH PLAN
SC2084681OtherAETNA HMO NETWORK
SC5787266001OtherCIGNA
SC0504373OtherPHYSICIANS HEALTH PLAN
SC201258Medicaid
SC5787266001OtherCIGNA
SC#13OtherUNITED HEALTHPLAN
SCF90332Medicare UPIN