Provider Demographics
NPI:1952353542
Name:GAMBRELL, ROBERT CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLAYTON
Last Name:GAMBRELL
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 1:4381 DEERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 N BELAIR RD STE 2B
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3190
Practice Address - Country:US
Practice Address - Phone:706-774-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA36747207Q00000X
SC28706207QS0010X
GA036747207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG36747Medicaid
GA000612411DMedicaid
SCAA36259198Medicare PIN
GA000612411DMedicaid
SCG36747Medicaid