Healthcare Provider Details

I. General information

NPI: 1699730747
Provider Name (Legal Business Name): STEPHEN L GILBREATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HOSPITAL CIRCLE
DONALSONVILLE GA
39845
US

IV. Provider business mailing address

102 HOSPITAL CIRCLE
DONALSONVILLE GA
39845
US

V. Phone/Fax

Practice location:
  • Phone: 229-524-5217
  • Fax: 229-524-8114
Mailing address:
  • Phone: 229-524-5217
  • Fax: 229-524-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34522
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: