Provider Demographics
NPI:1366514630
Name:MUSE, GEORGE E JR (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:MUSE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:E
Other - Last Name:MUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:156 NATURES TRL
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2005
Mailing Address - Country:US
Mailing Address - Phone:704-873-2624
Mailing Address - Fax:
Practice Address - Street 1:156 NATURES TRL
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-2005
Practice Address - Country:US
Practice Address - Phone:704-873-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE0910OtherMEDCOST
NC046J4OtherBLUE CROSS BLUE SHIELD
NC6000612Medicaid
NC6000612Medicaid