Provider Demographics
NPI:1336180264
Name:GIESLER, GARNETT J JR (MD)
Entity type:Individual
Prefix:
First Name:GARNETT
Middle Name:J
Last Name:GIESLER
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 1:303 SMITH ST
Mailing Address - Street 2:CLARK-HOLDER CLINIC, P.A.
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2745
Mailing Address - Country:US
Mailing Address - Phone:706-882-8831
Mailing Address - Fax:706-812-4091
Practice Address - Street 1:303 SMITH ST
Practice Address - Street 2:CLARK-HOLDER CLINIC, P.A.
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2745
Practice Address - Country:US
Practice Address - Phone:706-882-8831
Practice Address - Fax:706-812-4091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12467207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D39944Medicare UPIN