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General NPI Number Information
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NPI Number | 1043398605
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Entity Type | Individual
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Provider Name | EARLE WALCOTT GUNN III M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 245 FLOYD DR
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City | ATHENS
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State | GA
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Zip | 30607-1469
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Country | US
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Telephone | 762-356-4780
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Fax |
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Provider Business Mailing Address
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Address Line | 3320 OLD JEFFERSON RD BLDG 800
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City | ATHENS
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State | GA
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Zip | 30607-1400
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Country | US
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Telephone | 706-353-2990
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Fax | 706-353-2992
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 026538
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 026538
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License Number State | GA
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