Provider Demographics
NPI:1184259277
Name:BRUCE, GREGORY VARNEAL
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:VARNEAL
Last Name:BRUCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 ABERCORN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5597
Mailing Address - Country:US
Mailing Address - Phone:912-308-4087
Mailing Address - Fax:912-349-4524
Practice Address - Street 1:55 PEARL ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-5910
Practice Address - Country:US
Practice Address - Phone:912-308-4087
Practice Address - Fax:912-349-4524
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies