MEDICARE: DOCTOR G FAMILY MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1518476183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTOR G FAMILY MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	902B ROANOKE AVE
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-5565
Country	:	US
Telephone Number	:	252-368-8575
Fax Number	:	252-429-1611

Provider Business Practice Location Address
First Line	:	902B ROANOKE AVE
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-5565
Country	:	US
Telephone Number	:	252-368-8575
Fax Number	:	252-429-1611

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS VAUGHN GIGUIERE
Credential	:	MD
Telephone Number	:	252-368-8575

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	07/21/2022

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