Provider Demographics
NPI:1205836822
Name:GILMORE, GEORGE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:GILMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5398
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-0598
Mailing Address - Country:US
Mailing Address - Phone:706-866-2740
Mailing Address - Fax:706-861-3944
Practice Address - Street 1:4700 BATTLEFIELD PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5166
Practice Address - Country:US
Practice Address - Phone:706-866-2740
Practice Address - Fax:706-861-3944
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33333208600000X
TN36331208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00627701BMedicaid
GA00627701BMedicaid
TN3877977Medicare PIN
GA02BBGGFMedicare PIN