Provider Demographics
NPI:1245495142
Name:GEORGE R SMALL JR MD PC
Entity type:Organization
Organization Name:GEORGE R SMALL JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMALL, JR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-422-5490
Mailing Address - Street 1:284 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3634
Mailing Address - Country:US
Mailing Address - Phone:317-888-7745
Mailing Address - Fax:
Practice Address - Street 1:284 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3634
Practice Address - Country:US
Practice Address - Phone:317-888-7745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022870A173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
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