Provider Demographics
NPI:1215002720
Name:MERCER, GWENDOLYN MORE (MD)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:MORE
Last Name:MERCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 CHARLES GILMAN JR AVE STE A
Mailing Address - Street 2:SUITE C
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-5662
Mailing Address - Country:US
Mailing Address - Phone:912-576-0402
Mailing Address - Fax:912-729-8821
Practice Address - Street 1:701 CHARLES GILMAN JR AVE STE A
Practice Address - Street 2:SUITE C
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-5662
Practice Address - Country:US
Practice Address - Phone:912-576-0402
Practice Address - Fax:912-729-8821
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME626032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32124BMedicare ID - Type Unspecified
G32476Medicare UPIN