Provider Demographics
NPI:1255602116
Name:GCFM LLC
Entity type:Organization
Organization Name:GCFM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-265-6711
Mailing Address - Street 1:160 JUNIPER CT STE 101
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1952
Mailing Address - Country:US
Mailing Address - Phone:912-265-6711
Mailing Address - Fax:
Practice Address - Street 1:160 JUNIPER CT STE 101
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1952
Practice Address - Country:US
Practice Address - Phone:912-265-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35688261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care