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General NPI Number Information
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NPI Number | 1912159062
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Entity Type | Organization
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Legal Business Name | GAMMA ADULT CARE, P.C.
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 107 OSIGIAN BLVD SUITE 100
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City | WARNER ROBINS
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State | GA
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Zip | 31088-7891
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Country | US
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Telephone | 478-953-2212
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Fax | 478-953-2228
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Provider Business Mailing Address
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Address Line | PO BOX 8594
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City | WARNER ROBINS
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State | GA
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Zip | 31095-8594
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Country | US
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Telephone | 478-953-2212
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Fax | 478-953-2228
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY MYRTHIL
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Credential | MD
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Telephone | 478-953-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 038886
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License Number State | GA
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