Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 014906 | GA |
NPI | 1154381861 |
---|---|
Provider Name | Dr. George Jeryl Everidge |
First Address | Columbus, GA 31908-8983 |
Second Address | Columbus, GA 31904-6805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00151841A | (05) | GA |
11D0266507 | CLIA ID # (01) | GA |
E53960 | (02) | GA |