Basic Information
| Provider Information | |||||||||
| NPI: | 1932589959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | MORGAN | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 SOMERSET BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHARLES TOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254143952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047252663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 912 SOMERSET BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHARLES TOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254143952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047252663 | ||||||||
| FaxNumber: | 3047240053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 02/07/2018 | ||||||||
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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 | 363LF0000X | 98711 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2301792 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.