Provider Demographics
NPI:1952340291
Name:GASKIN, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GASKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 EISENHOWER DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1600
Mailing Address - Country:US
Mailing Address - Phone:912-443-4200
Mailing Address - Fax:912-350-0602
Practice Address - Street 1:340 EISENHOWER DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1600
Practice Address - Country:US
Practice Address - Phone:912-443-4200
Practice Address - Fax:912-350-0602
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA032736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00630156OtherRR MEDICARE
GA01207618OtherAMERIGROUP
SCG32736Medicaid
GA000421275IMedicaid
GA11BDRQZOtherOLD MEDICARE ID FOR CMG
GA11BDRQZMedicare ID - Type Unspecified
GA000421275IMedicaid
GA511I110482Medicare PIN