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General NPI Number Information
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NPI Number | 1952353542
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Entity Type | Individual
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Provider Name | ROBERT CLAYTON GAMBRELL MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 465 N BELAIR RD STE 2B
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City | EVANS
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State | GA
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Zip | 30809-3190
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Country | US
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Telephone | 706-774-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 4381 DEERWOOD LN
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City | EVANS
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State | GA
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Zip | 30809-4605
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36747
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 28706
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 036747
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License Number State | GA
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