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NPI Code Detail

MEDICARE: DR. GREGORY NORKUS M.D.

MEDICARE: DR. GREGORY NORKUS 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
12086S0129XVascular Surgery Physician5216AK
2208600000XSurgery Physician038317GA

General Provider Information

NPI Number : 1780672287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY NORKUS M.D.
Provider Business Mailing Address
First Line : PO BOX 407
Second Line :
City : VIDALIA
State : GA
Zip : 30475-0407
Country : US
Telephone Number : 912-537-4986
Fax Number : 912-538-8166
Provider Business Practice Location Address
First Line : 1811 EDWINA DR
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8963
Country : US
Telephone Number : 912-538-9977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 12/21/2018

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