Healthcare Provider Details

I. General information

NPI: 1578602900
Provider Name (Legal Business Name): GEORGE S GUMANN JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MARTIN LOOP MARTIN ARMY HOSPITAL
FORT BENNING GA
31905
US

IV. Provider business mailing address

6526 BILLINGS LAKE DR
COLUMBUS GA
31909-4446
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-3278
  • Fax: 706-544-2022
Mailing address:
  • Phone: 706-568-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number479
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: