Basic Information
| Provider Information | |||||||||
| NPI: | 1376630988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | NEOMA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 COLISEUM DR STE 445 | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236665981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578272127 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 COLISEUM DR STE 445 | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236665981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578272127 | ||||||||
| FaxNumber: | 7578272255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 24166019 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 363LF0000X | 0024166019 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 78563N | 01 | VA | OPTIMA | OTHER |