Basic Information
| Provider Information | |||||||||
| NPI: | 1144334285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEORGITIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WILSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CAPE FEAR CIR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SNEADS FERRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284609191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103272277 | ||||||||
| FaxNumber: | 9103272280 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 CAPE FEAR CIR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SNEADS FERRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284609191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103272277 | ||||||||
| FaxNumber: | 9103272280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 27795 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207K00000X | 27795 | NC | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 2080P0201X | 27795 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | 2080P0214X | 27795 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | 1217781 | 01 | UNITED HEALTHCARE | OTHER | 128AY | 01 | BLUE CROSS BLUE SHIELD | OTHER | 5904088 | 05 | NC | MEDICAID |