Provider Demographics
NPI:1437198983
Name:GUSSLER, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:GUSSLER
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 102635
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2635
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:912-629-5821
Practice Address - Street 1:4720 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6292
Practice Address - Country:US
Practice Address - Phone:912-354-4800
Practice Address - Fax:912-629-5821
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038788207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000613148HOtherMEDICAID - STATESBORO
GA000613148IOtherMEDICAID - SAVANNAH
GA00613148AMedicaid
GA1437198983OtherMEDICARE RAILROAD
473378OtherBLUE CROSS BLUE SHIELD
SCG38788Medicaid
SCGPA977OtherMEDICAID GRP. -SAV
GA000613148GOtherMEDICAID - CLAXTON
GA511G701032OtherGA MEDICARE GROUP
GA000613148HOtherMEDICAID - STATESBORO
GA18BDCSZMedicare PIN
GA511G701032OtherGA MEDICARE GROUP
473378OtherBLUE CROSS BLUE SHIELD
GA6150410002Medicare NSC
0412940004Medicare NSC
GA511I2180076Medicare PIN
GA000613148IOtherMEDICAID - SAVANNAH
SCG38788Medicaid
GA0412940001Medicare NSC
GA0412940007Medicare NSC
GA180019130Medicare PIN