Provider Demographics
NPI:1871460139
Name:BLAIR, GEORGE MITCHELL JR (MED)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MITCHELL
Last Name:BLAIR
Suffix:JR
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BENS TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-7000
Mailing Address - Country:US
Mailing Address - Phone:817-514-1544
Mailing Address - Fax:817-446-2051
Practice Address - Street 1:250 BENS TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-7000
Practice Address - Country:US
Practice Address - Phone:817-514-1544
Practice Address - Fax:817-446-2051
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61512101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor