MEDICARE: DR. BRIAN ERIC GAUPP 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
1	207RH0003X	Hematology & Oncology Physician	047594	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	830007293	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	52782026	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649265430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN ERIC GAUPP M.D.

Provider Business Mailing Address
First Line	:	920 CAIRO RD
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-4255
Country	:	US
Telephone Number	:	229-228-2970
Fax Number	:	229-551-8730

Provider Business Practice Location Address
First Line	:	919 S BROAD ST
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-6114
Country	:	US
Telephone Number	:	229-584-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2005
Last Update Date	:	09/17/2020

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