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NPI Code Detail

MEDICARE: RUSSELL G. GADDY M.D.

MEDICARE: RUSSELL G. GADDY M.D.
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician007870SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CM7824OTHERSCMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2207QG0300XOTHERSCTAXONOMY CODE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417146127
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL G. GADDY M.D.
Provider Business Mailing Address
First Line : 10 WINCHESTER CT
Second Line :
City : MAULDIN
State : SC
Zip : 29662-2627
Country : US
Telephone Number : 864-458-9999
Fax Number : 864-234-7652
Provider Business Practice Location Address
First Line : 10 WINCHESTER CT
Second Line :
City : MAULDIN
State : SC
Zip : 29662-2627
Country : US
Telephone Number : 864-458-9999
Fax Number : 864-234-7652
Authorized Official
Title or Position : DR
Name : DR. RUSSELL G. GADDY
Credential : MD
Telephone Number : 864-458-9999
Provider Enumeration Date : 10/18/2007
Last Update Date : 01/07/2013

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