Provider Demographics
NPI:1932111234
Name:GATLIN, DEBORAH ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:GATLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 COMMUNITY RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3085
Mailing Address - Country:US
Mailing Address - Phone:228-575-7243
Mailing Address - Fax:228-575-7420
Practice Address - Street 1:15200 COMMUNITY RD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3085
Practice Address - Country:US
Practice Address - Phone:228-575-7243
Practice Address - Fax:228-575-7420
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05420520Medicaid
P00712134Medicare PIN
MS512I110286Medicare PIN
P00428223Medicare PIN
MS05420520Medicaid
MS110001851Medicare PIN