Provider Demographics
NPI:1184801003
Name:MCCAMMON, GEORGE WILLIAM JR (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:MCCAMMON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 916
Mailing Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-0916
Mailing Address - Country:US
Mailing Address - Phone:800-968-0051
Mailing Address - Fax:
Practice Address - Street 1:5900 BYRON CENTER AVE SW
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9606
Practice Address - Country:US
Practice Address - Phone:800-968-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017209207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine