Active NPI
George Mark Coram, RD
- Registered Dietitian
- Prescott, AZ
National Provider Identifier
1245348408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 11982
- Practice address
- Navahcs 500 N Hwy 89
Prescott, AZ 86313 - Phone
- (928) 445-4860
- Fax
- (928) 717-7423
- NPI assigned
- Aug 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 11982 | IL | Primary |
Addresses
Primary practice location
Navahcs 500 N Hwy 89
Prescott, AZ 86313
Mailing address
11850 E Arabian LN
Dewey, AZ 86327-6001
Phone (928) 445-4860
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11982 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245348408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11850 E ARABIAN LN",
"city": "DEWEY",
"state": "AZ",
"postal_code": "863276001",
"telephone_number": "928-445-4860",
"fax_number": "928-717-7423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVAHCS 500 N HWY 89",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "86313",
"telephone_number": "928-445-4860",
"fax_number": "928-717-7423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORAM",
"first_name": "GEORGE",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "11982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.