Provider Demographics
NPI:1154307510
Name:MAULSBY, GILBERT ORSON (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:ORSON
Last Name:MAULSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAULSBY
Other - Middle Name:MEDICAL
Other - Last Name:P.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7629 RIVER CREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2025
Mailing Address - Country:US
Mailing Address - Phone:706-641-8272
Mailing Address - Fax:
Practice Address - Street 1:7629 RIVER CREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2025
Practice Address - Country:US
Practice Address - Phone:706-641-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0122262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G707915OtherMEDICARE GROUP NUMBER FOR CDC ON COMER
GAP00882633OtherRR MEDICARE
GA000280904CMedicaid
GA202I308285Medicare PIN
GA202G707915OtherMEDICARE GROUP NUMBER FOR CDC ON COMER
F10534Medicare UPIN