Provider Demographics
NPI:1063547255
Name:SAUNDERS, GEORGE LACRUSIE III (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LACRUSIE
Last Name:SAUNDERS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-0029
Mailing Address - Country:US
Mailing Address - Phone:910-499-0181
Mailing Address - Fax:888-316-8183
Practice Address - Street 1:602 THOMASBORO ROAD
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-9820
Practice Address - Country:US
Practice Address - Phone:910-499-0181
Practice Address - Fax:910-888-3168
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35741207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080047334OtherMEDICARE RAILROAD
NC76588OtherINDIVIDUAL BCBS
NC8974601Medicaid
NC8974601Medicaid
NC2172592CMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER