Provider Demographics
NPI:1689126849
Name:GEORGE, DAVID MICHAEL
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 WINEGARD DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5837
Mailing Address - Country:US
Mailing Address - Phone:636-220-3090
Mailing Address - Fax:888-439-4702
Practice Address - Street 1:134 ENCHANTED PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5495
Practice Address - Country:US
Practice Address - Phone:636-220-3090
Practice Address - Fax:888-439-4702
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator