Basic Information
Provider Information
NPI: 1760893929
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEORGE
FirstName: CHRISTINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1447 N HARRISON ST
Address2:  
City: SAGINAW
State: MI
PostalCode: 486024727
CountryCode: US
TelephoneNumber: 9895836521
FaxNumber:  
Practice Location
Address1: 50 N PERRY ST
Address2:  
City: PONTIAC
State: MI
PostalCode: 483422217
CountryCode: US
TelephoneNumber: 2483385000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/09/2014
LastUpdateDate: 03/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XL822789MIN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X5101020928MIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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