Basic Information
| Provider Information | |||||||||
| NPI: | 1093927097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BROWN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705334786 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305114000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067762368 | ||||||||
| FaxNumber: | 7067762589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 044464 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000763199J | 05 | GA | MEDICAID | 000763199H | 05 | GA | MEDICAID | 000763199M | 05 | GA | MEDICAID | 000763199E | 05 | GA | MEDICAID | 000763199K | 05 | GA | MEDICAID | 000763199I | 05 | GA | MEDICAID | 000763199G | 05 | GA | MEDICAID | 000763199L | 05 | GA | MEDICAID |