George James Antolick, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

204 W Hill Blvd
Charleston AFB, SC 29404-4704

Phone

(843) 963-6743

NPI assigned

Jul 29, 2009

Last updated

Jul 29, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• United States Air Force

  • Clinic/Center
  • Charleston AFB, SC
  • NPI 1023246659
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248825600000",
    "number": "1417188137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 HOUSTON DR",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294566257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W HILL BLVD",
            "city": "CHARLESTON AFB",
            "state": "SC",
            "postal_code": "294044704",
            "telephone_number": "843-963-6743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOLICK",
        "first_name": "GEORGE",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-29",
        "last_updated": "2009-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 628TH Medgrp-Charleston (Dod Charleston AFB Pharmacy)
• 628TH Medgrp-Charleston
• Karen Berkeley, PHARMD
• Shannon L Bolen, MSW
• James Edwin Boyd, M.D.
• Robert Ray Bryant, PA
• Michelle Karen Calandra, RN

• Independent Duty Medical Technicians in Charleston AFB, SC
• Providers in Charleston AFB, SC by specialty
• Independent Duty Medical Technicians in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.