Provider Demographics
NPI:1558662379
Name:GILBERT R GHEARING
Entity Type:Organization
Organization Name:GILBERT R GHEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:GHEARING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-243-5259
Mailing Address - Street 1:100 OLD JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-4040
Mailing Address - Country:US
Mailing Address - Phone:931-243-5259
Mailing Address - Fax:931-243-5156
Practice Address - Street 1:100 OLD JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-4040
Practice Address - Country:US
Practice Address - Phone:931-243-5259
Practice Address - Fax:931-243-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3018363Medicaid
TN103G706383Medicare PIN