Provider Demographics
NPI:1497850440
Name:GAUNT, GEORGE LOREN JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LOREN
Last Name:GAUNT
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16600 BIRKDALE CMNS PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6181
Mailing Address - Country:US
Mailing Address - Phone:704-896-1876
Mailing Address - Fax:704-896-1863
Practice Address - Street 1:16600 BIRKDALE CMNS PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6181
Practice Address - Country:US
Practice Address - Phone:704-896-1876
Practice Address - Fax:704-896-1863
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27047208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34982OtherBLUE CROSS BLUE SHIELD
NC34982OtherBLUE CROSS BLUE SHIELD