Provider Demographics
NPI:1437196532
Name:GILBERT, MAURICE BENARD (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:BENARD
Last Name:GILBERT
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 73709
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-3709
Mailing Address - Country:US
Mailing Address - Phone:770-251-2060
Mailing Address - Fax:678-854-9235
Practice Address - Street 1:80 NEWNAN STATION DRIVE, SUITE A
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-251-2060
Practice Address - Fax:678-854-9235
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050166207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherCHAMPUS/TRICARE
P00178221OtherRAILROAD MEDICARE
GAF68820Medicare UPIN
GA1437196532OtherNPI
GA000918156IMedicaid
GA1982637419OtherGROUP NPI
GA327216OtherWELLCARE MEDICAID
GA05BDJZTMedicare PIN
GA697003OtherBCBSGA (NSC)
GA697283OtherBCBSGA (AMC
GA000918156HMedicaid