Basic Information
| Provider Information | |||||||||
| NPI: | 1396703419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAULE | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 204097 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068559860 | ||||||||
| FaxNumber: | 7068607124 | ||||||||
| Practice Location | |||||||||
| Address1: | 3651 WHEELER RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309096521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068559860 | ||||||||
| FaxNumber: | 7068607124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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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 | 367500000X | RN092875 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | GAN130 | 05 | SC | MEDICAID | 000561558I | 05 | GA | MEDICAID | 10063588 | 01 | GA | AMERIGROUP | OTHER | 430077074 | 01 | GA | RAILROAD MEDICARE | OTHER |