| Name: | Fred George Ph.D., P.A. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Association |
| Status: | Exists |
| Date of registration: | 30 Jun 1980 (44 years ago) (Companies founded in June 1980) |
| Entity Number: | 000-061-023 |
| Register Number: | 000061023 |
| ZIP code: | 36330 (Companies in Coffee, 36330) |
| County: | Coffee |
| Place of Formation: | Coffee County |
| Principal Address: | 106 SOUTH CONNER STREETENTERPRISE, AL 36330 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548418452 | 2008-09-04 | 2008-09-04 | 1275 JAMES DR, SUITE A, ENTERPRISE, AL, 363302063, US | 1275 JAMES DR, SUITE A, ENTERPRISE, AL, 363302063, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 334-347-1862 |
| Fax | 3343472919 |
Authorized person
| Name | DR. FRED GEORGE |
| Role | PSYCHOLOGIST |
| Phone | 3343471862 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 143 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 890001970 |
| State | AL |
| Name | Role |
|---|---|
| GEORGE, FRED | Member |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
