Provider Demographics
NPI:1174103303
Name:GAULDIN, AUSTIN RYAN (DO)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:RYAN
Last Name:GAULDIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1665 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-6556
Mailing Address - Country:US
Mailing Address - Phone:662-377-2189
Mailing Address - Fax:
Practice Address - Street 1:247 WALTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-6556
Practice Address - Country:US
Practice Address - Phone:205-670-9690
Practice Address - Fax:205-670-9709
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.3817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine