Provider Demographics
NPI:1306946454
Name:GABRIEL, GEOFFREY MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:MATTHEW
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:414 PETTIGRU ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601
Mailing Address - Country:US
Mailing Address - Phone:864-404-9706
Mailing Address - Fax:864-438-4744
Practice Address - Street 1:414 PETTIGRU ST
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601
Practice Address - Country:US
Practice Address - Phone:864-404-9706
Practice Address - Fax:864-438-4744
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC#306632084P0800X, 2084P0802X, 2084P0805X, 2084P0800X
SC306632084P0800X, 2084P0802X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA29133361Medicare PIN
SCI627397951Medicare PIN
SC306635Medicaid
SCAA29134464Medicare PIN