Provider Demographics
NPI:1376541151
Name:GAULT, JAMES HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARVEY
Last Name:GAULT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 OKATIE BLVD SOUTH
Mailing Address - Street 2:STE 101
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909
Mailing Address - Country:US
Mailing Address - Phone:843-707-0222
Mailing Address - Fax:912-650-6805
Practice Address - Street 1:8 OKATIE BLVD SOUTH
Practice Address - Street 2:STE 101
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909
Practice Address - Country:US
Practice Address - Phone:843-707-0222
Practice Address - Fax:912-650-6805
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA049758207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060067597OtherRR MEDICARE
SC222164Medicaid
GA893747OtherBLUECROSS BLUESHIELD
GA000909444JMedicaid
GA060067597OtherRR MEDICARE
GA000909444JMedicaid
SCB333734768Medicare PIN