Provider Demographics
NPI:1295805570
Name:HOUSTON, G. COURTNEY (MD)
Entity type:Individual
Prefix:DR
First Name:G. COURTNEY
Middle Name:
Last Name:HOUSTON
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 1:416 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6644
Mailing Address - Country:US
Mailing Address - Phone:229-228-7200
Mailing Address - Fax:229-228-5193
Practice Address - Street 1:416 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6644
Practice Address - Country:US
Practice Address - Phone:229-228-7200
Practice Address - Fax:229-228-5193
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018675174400000X
GA186752086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA238212HOOtherBCBS
GA000210779AMedicaid
GA238212HOOtherBCBS