Active NPI
Kelley William George, MD
- Pediatrics Physician
- Sonora, CA
National Provider Identifier
1396721171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G062899
- Practice address
- 12791 Cabezut Rd
Sonora, CA 95370-5926 - Phone
- (209) 532-5524
- NPI assigned
- Dec 22, 2005
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G062899 | CA | Primary |
Addresses
Primary practice location
12791 Cabezut Rd
Sonora, CA 95370-5926
Mailing address
12791 Cabezut Rd
Sonora, CA 95370-5926
Phone (209) 532-5524
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G062899 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385078400000",
"number": "1396721171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12791 CABEZUT RD",
"city": "SONORA",
"state": "CA",
"postal_code": "953705926",
"telephone_number": "209-532-5524",
"fax_number": "209-532-1513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12791 CABEZUT RD",
"city": "SONORA",
"state": "CA",
"postal_code": "953705926",
"telephone_number": "209-532-5524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEORGE",
"first_name": "KELLEY",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2013-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G062899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sonora, CA
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- Sunni Erika Gessel, PMHNP-BC
- Arlene S Giordano, PHD
- Gold County Counseling a Licensed Clinical Social Worker Professional Corporation
- Gold Rush Home-Study Charter School
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.