Provider Demographics
NPI:1265479000
Name:ESSELMAN, GREGORY HUBERT (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:HUBERT
Last Name:ESSELMAN
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 1:340 NORTH BELAIR ROAD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3000
Mailing Address - Country:US
Mailing Address - Phone:706-868-5676
Mailing Address - Fax:706-722-2824
Practice Address - Street 1:121 AURORA PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:20596-3808
Practice Address - Country:US
Practice Address - Phone:803-649-0003
Practice Address - Fax:706-722-2824
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85176207YX0905X
SC29469207YX0905X
GA58966207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4516433Medicaid
SCGP4625Medicaid
SCGP4625Medicaid
SC8650Medicare PIN
CA4516433Medicaid