Provider Demographics
NPI:1811552029
Name:CORNELL, GEORGEANNE EMERSON (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGEANNE
Middle Name:EMERSON
Last Name:CORNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:GEORGEANNE
Other - Middle Name:EMERSON
Other - Last Name:ZITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6300 S SABINE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-9193
Mailing Address - Country:US
Mailing Address - Phone:573-864-2730
Mailing Address - Fax:
Practice Address - Street 1:1225 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-977-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020022923207ND0900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice