Provider Demographics
NPI:1841387115
Name:KAUFMAN, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KAUFMAN
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 1:1111 GLYNCO PARKWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525
Mailing Address - Country:US
Mailing Address - Phone:912-262-6552
Mailing Address - Fax:912-262-0112
Practice Address - Street 1:1111 GLYNCO PKWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7921
Practice Address - Country:US
Practice Address - Phone:912-267-6886
Practice Address - Fax:912-262-0112
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026571208VP0000X, 208VP0014X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00145647OtherRAILROAD
GAD70496Medicare UPIN
GAP00145647OtherRAILROAD