Provider Demographics
NPI:1124843974
Name:GEORGE, GRACE AN CATHERINE
Entity type:Individual
Prefix:
First Name:GRACE AN
Middle Name:CATHERINE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 3RD AVE APT 1208
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2097
Mailing Address - Country:US
Mailing Address - Phone:678-575-2759
Mailing Address - Fax:
Practice Address - Street 1:2357 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5668
Practice Address - Country:US
Practice Address - Phone:910-633-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician