Provider Demographics
NPI:1366881641
Name:D RAY GASKIN JR MD LLC
Entity type:Organization
Organization Name:D RAY GASKIN JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GASKIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:912-352-9902
Mailing Address - Street 1:315 COMMERCIAL DR STE B3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3631
Mailing Address - Country:US
Mailing Address - Phone:912-352-9902
Mailing Address - Fax:912-352-9960
Practice Address - Street 1:315 COMMERCIAL DR STE B3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3631
Practice Address - Country:US
Practice Address - Phone:912-352-9902
Practice Address - Fax:912-352-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002856101YA0400X
GA022469174400000X
GA028117207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45414Medicare UPIN