Provider Demographics
NPI:1861996365
Name:GEORGE, SALLY (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 W CENTRAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1498
Mailing Address - Country:US
Mailing Address - Phone:740-615-0450
Mailing Address - Fax:740-615-0462
Practice Address - Street 1:551 W CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1498
Practice Address - Country:US
Practice Address - Phone:740-615-0450
Practice Address - Fax:740-615-0462
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.148669208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery