Provider Demographics
NPI:1487716684
Name:SCHIMMEL, GEORGE B (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:B
Last Name:SCHIMMEL
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 1:346 CROSSGATES BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042
Mailing Address - Country:US
Mailing Address - Phone:601-825-2424
Mailing Address - Fax:601-825-7621
Practice Address - Street 1:346 CROSSGATES BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042
Practice Address - Country:US
Practice Address - Phone:601-825-2424
Practice Address - Fax:601-825-7621
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07894207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018972Medicaid
MS00018972Medicaid