Healthcare Provider Details

I. General information

NPI: 1629155676
Provider Name (Legal Business Name): DOUGLAS GRANVILLE GRESHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EISENHOWER DR 1600
SAVANNAH GA
31406-1600
US

IV. Provider business mailing address

340 EISENHOWER DR 1600
SAVANNAH GA
31406-1600
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-6029
  • Fax: 912-352-3071
Mailing address:
  • Phone: 912-355-6029
  • Fax: 912-352-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number026286
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: