Provider Demographics
NPI:1023102480
Name:CHILDRESS, GEORGE W (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:CHILDRESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 VIRGINIA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5639
Mailing Address - Country:US
Mailing Address - Phone:972-548-5377
Mailing Address - Fax:972-548-5447
Practice Address - Street 1:6171 VIRGINIA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5639
Practice Address - Country:US
Practice Address - Phone:972-548-5377
Practice Address - Fax:972-548-5447
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH2300OtherSTATE LICENSE
TX127805306Medicaid
TX127805306Medicaid
TXH2300OtherSTATE LICENSE