Provider Demographics
NPI:1093940694
Name:ATALLAH, GEORGE MICHEL (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHEL
Last Name:ATALLAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:MICHEL
Other - Last Name:ATALLAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:902 FROSTWOOD DR STE 235
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2417
Mailing Address - Country:US
Mailing Address - Phone:713-298-0120
Mailing Address - Fax:
Practice Address - Street 1:902 FROSTWOOD DR STE 235
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2417
Practice Address - Country:US
Practice Address - Phone:713-298-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X207L00000X
TXP1162208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7550310001Medicare NSC