Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 000848 | GA |
NPI | 1306841374 |
---|---|
Provider Name | Dr. George S Havrilla |
First Address | Thomson, GA 30824-2117 |
Second Address | Thomson, GA 30824-2117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 14/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10041458 | AMERIGROUP (01) | GA |
10581911 | CIGNA (01) | GA |
322007 | WELLCARE OF GEORGIA (01) | GA |
5040540001 | DME PROVIDER # (01) | GA |
52773057-003 | BLUE CROSS BLUE SHIELD (01) | GA |
5467067 | AETNA (01) | GA |
618552906A | (05) | GA |
U48308 | (02) | GA |