1205836822 NPI number — GEORGE THOMAS GILMORE MD

Table of content: GEORGE THOMAS GILMORE MD (NPI 1205836822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205836822 NPI number — GEORGE THOMAS GILMORE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILMORE
Provider First Name:
GEORGE
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205836822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5398
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT OGLETHORPE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30742-0598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-866-2740
Provider Business Mailing Address Fax Number:
706-861-3944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 BATTLEFIELD PKWY
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
RINGGOLD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30736-5166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-866-2740
Provider Business Practice Location Address Fax Number:
706-861-3944
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  33333 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 36331 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00627701B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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