Basic Information
| Provider Information | |||||||||
| NPI: | 1205817467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLUSKEY | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | MILTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7217 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319087217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063222462 | ||||||||
| FaxNumber: | 7063222891 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 MANCHESTER EXPY | ||||||||
| Address2: | STE 101A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063222462 | ||||||||
| FaxNumber: | 7063222891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 30342 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | #009939871 | 05 | AL | MEDICAID | 601-05060 | 01 | AL | BLUE CROSS BLUE SHILED OF ALABAMA | OTHER | 00430438I | 05 | GA | MEDICAID | 20NCCRR | 01 | GA | MEDICARE PTAN | OTHER | 000430438 | 05 | GA | MEDICAID | 52255395-006 | 01 | GA | BLUE CROSS BLUE SHIELD OF GEORGIA | OTHER |