Provider Demographics
NPI:1134568967
Name:BOOTHE, GEORGE AUSTIN (CRNP)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:AUSTIN
Last Name:BOOTHE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 WOODMERE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3084
Mailing Address - Country:US
Mailing Address - Phone:334-272-1050
Mailing Address - Fax:
Practice Address - Street 1:4770 WOODMERE BLVD STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3084
Practice Address - Country:US
Practice Address - Phone:334-272-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily