Provider Demographics
NPI:1649247925
Name:HARVEY, GARY NORMAN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:NORMAN
Last Name:HARVEY
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 1:907 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4612
Mailing Address - Country:US
Mailing Address - Phone:912-352-0129
Mailing Address - Fax:912-352-0130
Practice Address - Street 1:907 E 67TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4612
Practice Address - Country:US
Practice Address - Phone:912-352-0129
Practice Address - Fax:912-352-0130
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00181981BMedicaid
GAD40087Medicare UPIN