Provider Demographics
NPI:1831159185
Name:RUSHING, GEORGE VAN DYCK (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:VAN DYCK
Last Name:RUSHING
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:PO BOX 1000
Mailing Address - Street 2:DEPT 558
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0558
Mailing Address - Country:US
Mailing Address - Phone:901-821-8300
Mailing Address - Fax:901-821-8370
Practice Address - Street 1:6799 GREAT OAKS ROAD
Practice Address - Street 2:250
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-821-8300
Practice Address - Fax:901-821-8370
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3188068Medicare ID - Type Unspecified
B04314Medicare UPIN