Healthcare Provider Details

I. General information

NPI: 1750607222
Provider Name (Legal Business Name): GUNKEL CARDIOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

11702 MERCY BLVD SUITE 2D
SAVANNAH GA
31419-1750
US

IV. Provider business mailing address

11702 MERCY BLVD SUITE 2D
SAVANNAH GA
31419-1750
US

V. Phone/Fax

Practice location:
  • Phone: 912-721-2900
  • Fax: 912-721-2903
Mailing address:
  • Phone: 912-721-2900
  • Fax: 912-721-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14247
License Number StateGA

VIII. Authorized Official

Name: DR. DIETER K GUNKEL
Title or Position: OWNER
Credential: M.D.
Phone: 912-721-2900