Provider Demographics
NPI:1669419883
Name:GAY, ALFONSO JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:GAY
Suffix:JR
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:P.O. BOX 3847
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3847
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:302 UNIVERSITY PARKWAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29802
Practice Address - Country:US
Practice Address - Phone:803-641-5197
Practice Address - Fax:803-641-5690
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC268622085B0100X, 2085D0003X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356443683OtherNPI - CAROLINA RADIOLOGY
608241300OtherACS/OWCP/DEEOIC
608241301OtherACS/OWCP/FBL
608241301OtherACS/OWCP/DOL
SC268622Medicaid
GA00741254AMedicaid
608241303OtherACS/OWCP/FBL
202148722OtherTRICARE
SC202148722OtherBLUECROSSBLUE SHIELD
608241302OtherACS/OWCP/FBL
608241302OtherACS/OWCP/DOL
608241301OtherACS/OWCP/DOL
608241301OtherACS/OWCP/FBL
F81745Medicare UPIN