George A Devita
Individual provider Active NPI Medical Physician Assistant · Moody Afb, GA
NPI 1437526340 · NPPES record last updated Aug 26, 2015
Key facts
- NPI
- 1437526340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- Practice address
- 23D Medical Group 3278 Mitchell Blvd
Moody Afb, GA 31699-1793 - Phone
- (315) 783-5876
- NPI assigned
- Aug 26, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Yes |
Addresses
Primary practice location
23D Medical Group 3278 Mitchell Blvd
Moody Afb, GA 31699-1793
Mailing address
27082 Waddingham Rd
Evans Mills, NY 13637-3277
Phone (315) 783-5876
Other providers in Moody Afb, GA
- Elizabeth Guadalupe Chavez
- Scott M Cheney
- Emary Climacosa
- Rachel Collins
- Capri Delvaux
- Konstantine Dietrich
- Mark Brian Dudley
- Rachael Dawn Dudley
- Melissa Marylyn Durham
- Samantha Durham
All providers in Moody Afb, GA · Medical Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.