Provider Demographics
NPI:1487616454
Name:MINSON, GEORGE E (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:MINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9172
Mailing Address - Country:US
Mailing Address - Phone:843-797-1770
Mailing Address - Fax:843-377-1305
Practice Address - Street 1:2845 TRICOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9172
Practice Address - Country:US
Practice Address - Phone:843-797-1770
Practice Address - Fax:843-377-1305
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC099985Medicaid
SC110073908OtherRAILROAD MEDICARE ID#
SC110073908OtherRAILROAD MEDICARE ID#
SCB921643101Medicare PIN