Individual
MR. GEORGE EDWARD MCGOVERN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 WILDCAT LN, DESTREHAN, LA 70047-4001
(601) 433-3333
Mailing address
106 ARLINE CT, MONTZ, LA 70068-8978
(601) 433-3333
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.20088
LA
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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