Individual
GEORGE HURST PROVOSTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
209 WEST 27TH STREET, LUMBERTON, NC 28358-3016
(910) 738-8222
(910) 671-0846
Mailing address
P.O. BOX 1527, LUMBERTON, NC 28359-1527
(910) 738-8222
(910) 671-0846
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
000018135
NC
2085R0202X
Diagnostic Radiology Physician
Primary
18135
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69325
BLUE CROSS BLUE SHIELD
NC
05
—
8969325
—
NC
Enumeration date
08/24/2005
Last updated
07/20/2010
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