Deriso, George T

Deriso, George T is an individual health care provider with primary practice located at 1700 Hospital South Dr Suite 409, Austell GA 30106-6810. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Deriso, George T can be contacted via phone (770) 424-6893.

Contact Information

Primary practice address
1700 Hospital South Dr Suite 409 Austell GA 30106-6810
Phone: (770) 424-6893
Fax: (770) 528-9938
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 047732 Georgia

Profile Details

NPI number 1639396518
LBN Legal business name Deriso, George T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 20th, 2007
Last updated Oct 29th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639396518 NPPES
Georgia MEDICAID 000904208W
Georgia MEDICAID 000904208T
Georgia MEDICAID 000904208V
Georgia MEDICAID 000904208S

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