Individual
GEORGE T DERISO III
Active
Individual
GEORGE T DERISO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
047732
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000904208S
—
GA
05
—
000904208T
—
GA
05
—
000904208V
—
GA
05
—
000904208W
—
GA
Enumeration date
04/20/2007
Last updated
10/29/2019
Update your record
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