Physician Compare National (NPI:1629155676)

HEALTHCARE PROVIDER: DOUGLAS GRANVILLE GRESHAM M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629155676
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830270719
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120126000296
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRESHAM
	Individual professional last name
Provider First Name	DOUGLAS
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1979
	Individual professional's medical school graduation year
Primary Specialty	ENDOCRINOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	340 EISENHOWER DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1600
	Group Practice or individual's line 2 address
City	SAVANNAH
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	314061601
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110024
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CANDLER HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110043
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOSEPH'S HOSPITAL - SAVANNAH
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	420067
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BEAUFORT COUNTY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	111306
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	EFFINGHAM HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	420080
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	HILTON HEAD REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1629155676)

HEALTHCARE PROVIDER: DOUGLAS GRANVILLE GRESHAM M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information