Provider Demographics
NPI:1336885557
Name:GSW MEDICAL, LLC
Entity Type:Organization
Organization Name:GSW MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-341-2335
Mailing Address - Street 1:7470 WOODLAWN CT
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-5539
Mailing Address - Country:US
Mailing Address - Phone:318-341-2335
Mailing Address - Fax:
Practice Address - Street 1:4500 13TH ST FL 3
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2515
Practice Address - Country:US
Practice Address - Phone:318-341-2335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty