Provider Demographics
NPI:1306020276
Name:P. K. GEORGE MD PA
Entity type:Organization
Organization Name:P. K. GEORGE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAZHAYIDATHE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-269-9111
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-0247
Mailing Address - Country:US
Mailing Address - Phone:919-269-9111
Mailing Address - Fax:919-269-4747
Practice Address - Street 1:323 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2542
Practice Address - Country:US
Practice Address - Phone:919-269-9111
Practice Address - Fax:919-269-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC35107OtherBLUE CROSS BLUE SHIELD
NC2311119Medicare PIN