Provider Demographics
NPI:1295737930
Name:MAXWELL, GEORGE PATRICK (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PATRICK
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4354
Mailing Address - Country:US
Mailing Address - Phone:615-932-7700
Mailing Address - Fax:615-932-7707
Practice Address - Street 1:2020 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4354
Practice Address - Country:US
Practice Address - Phone:615-932-7700
Practice Address - Fax:615-932-7707
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13577208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D71883Medicare UPIN