Provider Demographics
NPI:1093020505
Name:GEORGE, WALES THOTTATHIKUNNATH (MD)
Entity type:Individual
Prefix:
First Name:WALES
Middle Name:THOTTATHIKUNNATH
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WALES
Other - Middle Name:
Other - Last Name:THOTTATHIKUNNATH GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 S MACGREGOR WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1032
Mailing Address - Country:US
Mailing Address - Phone:713-741-3830
Mailing Address - Fax:
Practice Address - Street 1:2800 S MACGREGOR WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1032
Practice Address - Country:US
Practice Address - Phone:713-741-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4610982084P0800X
TXV99042084P0800X
NC2014009562084P0800X
VA01012565762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry