Provider Demographics
NPI: | 1649361957 |
---|---|
Name: | COX, GEORGE DOUGLAS (PHD) |
Entity type: | Individual |
Prefix: | |
First Name: | GEORGE |
Middle Name: | DOUGLAS |
Last Name: | COX |
Suffix: | |
Gender: | M |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 445 W BLOUNT AVE # 412 |
Mailing Address - Street 2: | |
Mailing Address - City: | KNOXVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37920 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 865-386-6392 |
Mailing Address - Fax: | 865-314-8402 |
Practice Address - Street 1: | 445 W BLOUNT AVE # 412 |
Practice Address - Street 2: | |
Practice Address - City: | KNOXVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37920 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-386-6392 |
Practice Address - Fax: | 865-314-8402 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-09-28 |
Last Update Date: | 2025-09-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 894 | 103TS0200X |
TN | P0000000894 | 103TH0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3983065 | Medicaid | |
TN | 3983065 | Medicaid | |
TN | 3983065 | Medicare PIN |