Provider Demographics
NPI:1255737599
Name:GEORGE, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 GLENRIDGE CONNECTOR
Mailing Address - Street 2:STE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4758
Mailing Address - Country:US
Mailing Address - Phone:678-956-6531
Mailing Address - Fax:678-567-6530
Practice Address - Street 1:377 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3323
Practice Address - Country:US
Practice Address - Phone:516-537-9061
Practice Address - Fax:516-537-9061
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018054-1363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical