Provider Demographics
NPI:1134865470
Name:ISHMAN, GEORGE M (ALC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:ISHMAN
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 DREXEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3206
Mailing Address - Country:US
Mailing Address - Phone:334-220-6406
Mailing Address - Fax:
Practice Address - Street 1:2911 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2648
Practice Address - Country:US
Practice Address - Phone:334-262-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC4124A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty