Basic Information
| Provider Information | |||||||||
| NPI: | 1235236290 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 COLLEGE ST STE A | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312071500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783012397 | ||||||||
| FaxNumber: | 4783012128 | ||||||||
| Practice Location | |||||||||
| Address1: | 764 PINE ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783015801 | ||||||||
| FaxNumber: | 4783015812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/21/2012 | ||||||||
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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 | 207R00000X | 053453 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 916309744I | 05 | GA | MEDICAID |