Provider Demographics
NPI:1952335424
Name:GEORGI, EMIL B (MD)
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:B
Last Name:GEORGI
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 1:3025 BRECKINRIDGE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7611
Mailing Address - Country:US
Mailing Address - Phone:678-226-0082
Mailing Address - Fax:
Practice Address - Street 1:DODGE COUNTY HOSPITAL
Practice Address - Street 2:715 GRIFFIN AVE SW
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023
Practice Address - Country:US
Practice Address - Phone:478-448-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019048207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000276944BMedicaid
220003344Medicare PIN
D39939Medicare UPIN
GA$$$$$$$$$BMedicare PIN