Provider Demographics
NPI:1649361957
Name:COX, GEORGE DOUGLAS (PHD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:COX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6588
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-6588
Mailing Address - Country:US
Mailing Address - Phone:865-386-6392
Mailing Address - Fax:
Practice Address - Street 1:6710 AVENS LN
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:TN
Practice Address - Zip Code:37878-2383
Practice Address - Country:US
Practice Address - Phone:865-386-6392
Practice Address - Fax:888-484-0155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN894103TS0200X
TNP0000000894103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3983065Medicaid
TN3983065Medicaid
TN3983065Medicare PIN