Provider Demographics
NPI:1548880032
Name:GEORGE, MANU JACOB (MD)
Entity type:Individual
Prefix:MR
First Name:MANU JACOB
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1482
Mailing Address - Country:US
Mailing Address - Phone:404-301-4555
Mailing Address - Fax:404-301-4482
Practice Address - Street 1:1057 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1482
Practice Address - Country:US
Practice Address - Phone:404-301-4555
Practice Address - Fax:404-301-4482
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine