Healthcare Provider Details

I. General information

NPI: 1952398190
Provider Name (Legal Business Name): CLAUDE R GORDY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 UNIVERSITY PKWY AIKEN REGIONAL MEDICAL CENTER
AIKEN SC
29801-6302
US

IV. Provider business mailing address

3532 STEVENS WAY
MARTINEZ GA
30907-8901
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-5489
  • Fax: 803-641-5148
Mailing address:
  • Phone: 706-228-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR94916
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: