Provider Demographics
NPI:1396703419
Name:MAULE, GEORGE E (CRNA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:MAULE
Suffix:
Gender:M
Credentials:CRNA
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 204097
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-855-9860
Mailing Address - Fax:706-860-7124
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-855-9860
Practice Address - Fax:706-860-7124
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN092875367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGAN130Medicaid
GA000561558IMedicaid
GA10063588OtherAMERIGROUP
GA430077074OtherRAILROAD MEDICARE
GA000561558IMedicaid
GA10063588OtherAMERIGROUP