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General NPI Number Information
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NPI Number | 1336885557
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Entity Type | Organization
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Legal Business Name | GSW MEDICAL, LLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 4500 13TH ST FL 3
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City | GULFPORT
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State | MS
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Zip | 39501-2515
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Country | US
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Telephone | 318-341-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 7470 WOODLAWN CT
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-5539
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Country | US
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Telephone | 318-341-2335
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JOHN NOLAN GRADY
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Credential | MD
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Telephone | 318-341-2335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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