Provider Demographics
NPI:1871681478
Name:GAITHER, ANTHONY CLARK (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CLARK
Last Name:GAITHER
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 1:2607 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9437
Mailing Address - Country:US
Mailing Address - Phone:919-735-1251
Mailing Address - Fax:919-734-5183
Practice Address - Street 1:2607 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9437
Practice Address - Country:US
Practice Address - Phone:919-735-1251
Practice Address - Fax:919-734-5183
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22787OtherBLUE CROSS INDIVIDUAL #
NC0150COtherGROUP BLUE CROSS #
NC790150CMedicaid
NC7934317Medicaid
NC22787OtherBLUE CROSS INDIVIDUAL #
NC0150COtherGROUP BLUE CROSS #