Basic Information
| Provider Information | |||||||||
| NPI: | 1689619678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCASKILL | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 PARKWOOD DRIVE | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315204722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124667188 | ||||||||
| FaxNumber: | 9124667185 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 PARKWOOD DRIVE | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315204722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124667187 | ||||||||
| FaxNumber: | 9124667185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 02/17/2017 | ||||||||
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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 | 207QA0505X | 29624 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207R00000X | 063689 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 063689 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 259539700 | 05 | FL | MEDICAID | 296245 | 05 | SC | MEDICAID | 58619 | 01 | FL | BLUE CROSS & BLUE SHIELD | OTHER |