Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 27795 | NC |
Y | 207Q00000X | Family Doctor | 27795 | NC |
N | 2080P0201X | Pediatric Allergist | 27795 | NC |
N | 2080P0214X | Pediatric Pulmonologist | 27795 | NC |
NPI | 1144334285 |
---|---|
Provider Name | Dr. John Wilson Georgitis |
First Address | Sneads Ferry, NC 28460-9191 |
Second Address | Sneads Ferry, NC 28460-9191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 02/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1217781 | UNITED HEALTHCARE (01) | |
128AY | BLUE CROSS BLUE SHIELD (01) | |
5904088 | (05) | NC |
C84011 | (02) |