Provider Demographics
NPI:1518024363
Name:GREGORY H ESSELMAN MD LLC
Entity Type:Organization
Organization Name:GREGORY H ESSELMAN MD LLC
Other - Org Name:AIKEN ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:706-868-5676
Mailing Address - Street 1:340 NORTH BELAIR ROAD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3000
Mailing Address - Country:US
Mailing Address - Phone:706-868-5676
Mailing Address - Fax:706-722-2824
Practice Address - Street 1:121 AURORA PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3000
Practice Address - Country:US
Practice Address - Phone:706-868-5676
Practice Address - Fax:706-722-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29469207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4625Medicaid
SC29469OtherSTATE MEDICAL LICENSE
CAG50232Medicare UPIN
SC8650Medicare PIN