Provider Demographics
NPI:1588743868
Name:GEORGE, ACHENKUNJU K (MD, FACC, FC)
Entity type:Individual
Prefix:
First Name:ACHENKUNJU
Middle Name:K
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD, FACC, FC
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 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-257-5950
Mailing Address - Fax:417-257-5924
Practice Address - Street 1:1115 ALASKA ST STE 114
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2000
Practice Address - Country:US
Practice Address - Phone:417-257-5950
Practice Address - Fax:417-257-5924
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD106574207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207644501Medicaid
AR129018001Medicaid
MO207644501Medicaid
MOMA3073001Medicare PIN