Provider Demographics
NPI:1528669280
Name:MCGILL, GEORGE B III (LMT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:B
Last Name:MCGILL
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-1242
Mailing Address - Country:US
Mailing Address - Phone:614-400-7087
Mailing Address - Fax:
Practice Address - Street 1:773 ELM ST
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-1242
Practice Address - Country:US
Practice Address - Phone:614-400-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist