Healthcare Provider Details

I. General information

NPI: 1205836822
Provider Name (Legal Business Name): GEORGE THOMAS GILMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BATTLEFIELD PKWY SUITE 130
RINGGOLD GA
30736-5166
US

IV. Provider business mailing address

PO BOX 5398
FT OGLETHORPE GA
30742-0598
US

V. Phone/Fax

Practice location:
  • Phone: 706-866-2740
  • Fax: 706-861-3944
Mailing address:
  • Phone: 706-866-2740
  • Fax: 706-861-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33333
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36331
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: