Provider Demographics
NPI:1962061473
Name:MCBRIDE, GEORGE K (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:K
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:820 OLD PARKSVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-5010
Mailing Address - Country:US
Mailing Address - Phone:423-310-1283
Mailing Address - Fax:
Practice Address - Street 1:1723 MOUNT VERNON DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3539
Practice Address - Country:US
Practice Address - Phone:423-473-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25979363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health