1235155870 NPI number — DR. GEORGE LOUCION SNEED SR. PHD,MAC,NCAC,CAC,CCS

Table of content: DR. GEORGE LOUCION SNEED SR. PHD,MAC,NCAC,CAC,CCS (NPI 1235155870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235155870 NPI number — DR. GEORGE LOUCION SNEED SR. PHD,MAC,NCAC,CAC,CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNEED
Provider First Name:
GEORGE
Provider Middle Name:
LOUCION
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PHD,MAC,NCAC,CAC,CCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235155870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3609 ALENE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30906-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-733-0188
Provider Business Mailing Address Fax Number:
706-731-7288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 FREEDOM WAY
Provider Second Line Business Practice Location Address:
SATP/OPT CLININC
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-733-0188
Provider Business Practice Location Address Fax Number:
706-731-7288
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  500382 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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