Provider Demographics
NPI:1912159062
Name:GAMMA ADULT CARE, P.C.
Entity Type:Organization
Organization Name:GAMMA ADULT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRTHIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-953-2212
Mailing Address - Street 1:PO BOX 8594
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8594
Mailing Address - Country:US
Mailing Address - Phone:478-953-2212
Mailing Address - Fax:478-953-2228
Practice Address - Street 1:107 OSIGIAN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7891
Practice Address - Country:US
Practice Address - Phone:478-953-2212
Practice Address - Fax:478-953-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038886261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000620749BMedicaid
GA000620749BMedicaid