Provider Demographics
NPI:1992972681
Name:GEORGE K. GANAWAY, M.D., P.C.
Entity type:Organization
Organization Name:GEORGE K. GANAWAY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:GANAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-252-4525
Mailing Address - Street 1:5064 ROSWELL RD NE
Mailing Address - Street 2:STE D-201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2281
Mailing Address - Country:US
Mailing Address - Phone:404-252-4525
Mailing Address - Fax:404-252-6935
Practice Address - Street 1:5064 ROSWELL RD NE
Practice Address - Street 2:STE D-201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2281
Practice Address - Country:US
Practice Address - Phone:404-252-4525
Practice Address - Fax:404-252-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0162332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty