Healthcare Provider Details

I. General information

NPI: 1053653089
Provider Name (Legal Business Name): GABRIEL THORNTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 MEDICAL CENTER DR STE 2A
AUGUSTA GA
30909-6647
US

IV. Provider business mailing address

1109 MEDICAL CENTER DR STE 2A
AUGUSTA GA
30909-6647
US

V. Phone/Fax

Practice location:
  • Phone: 706-901-4242
  • Fax: 706-204-3058
Mailing address:
  • Phone: 706-901-4242
  • Fax: 706-204-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number82608
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number82608
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: