Provider Demographics
NPI:1932257052
Name:DORNBLAZER, GEORGE HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HENRY
Last Name:DORNBLAZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:447 SOUTH SHARON AMITY ROAD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2922
Mailing Address - Country:US
Mailing Address - Phone:704-342-2577
Mailing Address - Fax:704-333-3102
Practice Address - Street 1:447 SOUTH SHARON AMITY ROAD
Practice Address - Street 2:SUITE 245
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2922
Practice Address - Country:US
Practice Address - Phone:704-342-2577
Practice Address - Fax:704-333-3102
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC288532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry