Provider Demographics
NPI:1760453286
Name:GEORGE, GARTH O (MD)
Entity type:Individual
Prefix:DR
First Name:GARTH
Middle Name:O
Last Name:GEORGE
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 1:8110 COUNTY ROAD 44 LEG A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3704
Mailing Address - Country:US
Mailing Address - Phone:352-323-8868
Mailing Address - Fax:735-232-3885
Practice Address - Street 1:8110 COUNTY ROAD 44 LEG A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3704
Practice Address - Country:US
Practice Address - Phone:352-323-8868
Practice Address - Fax:735-232-3885
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-00366207RG0100X
FLME82112207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128W6Medicaid
FL004055500Medicaid
NC2286121Medicare ID - Type Unspecified
NC89128W6Medicaid
FL004055500Medicaid