Provider Demographics
NPI:1073509105
Name:LIGHT, GERALD S (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:S
Last Name:LIGHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3564B NORTHCROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1067
Mailing Address - Country:US
Mailing Address - Phone:229-247-1414
Mailing Address - Fax:229-247-1978
Practice Address - Street 1:3564B NORTHCROSSING CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1067
Practice Address - Country:US
Practice Address - Phone:229-247-1414
Practice Address - Fax:229-247-1978
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA018237207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39BDCKPMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GAD30066Medicare UPIN