Provider Demographics
NPI:1083643142
Name:KOULIANOS, GEORGE T (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:KOULIANOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-438-4200
Mailing Address - Fax:251-438-4211
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:SUITE 213
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-438-4200
Practice Address - Fax:251-438-4211
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL15405207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL88782OtherBLUE CROSS
AL051088782Medicaid
ALE47451Medicare UPIN
AL88782OtherBLUE CROSS