Provider Demographics
NPI:1538219399
Name:TARBUTTON, GEORGE LESTER (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LESTER
Last Name:TARBUTTON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-425-7550
Mailing Address - Fax:601-399-6281
Practice Address - Street 1:1430 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4243
Practice Address - Country:US
Practice Address - Phone:601-425-2273
Practice Address - Fax:601-426-9637
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS189012083X0100X
AL296982083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04507731Medicaid
MS359065YZY3Medicare PIN
AL51105375OtherBC PROVIDER #
ALBT9248736OtherDEA
AL102I841723Medicare PIN