Basic Information
| Provider Information | |||||||||
| NPI: | 1558354076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MOSE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 MEREDYTH DR | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317072267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298837010 | ||||||||
| FaxNumber: | 2294354022 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 MEREDYTH DR | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317072267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298837010 | ||||||||
| FaxNumber: | 2294354022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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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 | 207VG0400X | 012125 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00015133A | 05 | GA | MEDICAID |