Provider Demographics
NPI:1881697761
Name:SNOWDEN, GEORGIANNE M (MD)
Entity type:Individual
Prefix:
First Name:GEORGIANNE
Middle Name:M
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 NW 56TH ST, SUITE C-40
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-945-4741
Mailing Address - Fax:888-972-5320
Practice Address - Street 1:3433 NW 56TH ST, SUITE C-40
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-945-4741
Practice Address - Fax:888-972-5320
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK165392085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100041410AMedicaid
OKP00171214OtherRAILROAD MEDICARE /AI
OKP00144996OtherRAILROAD MEDICARE
OK242419509Medicare ID - Type Unspecified
OKP00144996Medicare PIN
OKMDLPL015Medicare ID - Type Unspecified
OKP00144996OtherRAILROAD MEDICARE
OKP00171214OtherRAILROAD MEDICARE /AI
OKE41027Medicare UPIN
OK244421014Medicare ID - Type Unspecified
OK100041410AMedicaid