MEDICARE: GBM ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1386642015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBM ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 6127
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30722-6127
Country	:	US
Telephone Number	:	706-277-0106
Fax Number	:	706-270-5858

Provider Business Practice Location Address
First Line	:	1507 PROFESSIONAL CT
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2500
Country	:	US
Telephone Number	:	706-277-0700
Fax Number	:	706-277-0076

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DANA G PURCELL
Credential	:
Telephone Number	:	706-277-0106

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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Directions to “GBM ENTERPRISES, INC. ” Practice Location

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