Provider Demographics
NPI:1346221595
Name:KLEMANN, GILBERT SOUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:SOUTH
Last Name:KLEMANN
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 1:535 REGENT RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3114
Mailing Address - Country:US
Mailing Address - Phone:706-737-1963
Mailing Address - Fax:229-431-1951
Practice Address - Street 1:1001 N MONROE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1903
Practice Address - Country:US
Practice Address - Phone:229-436-7248
Practice Address - Fax:229-431-1951
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00089812AMedicaid
GA00089812AMedicaid