Provider Demographics
NPI:1699730747
Name:GILBREATH, STEPHEN L (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:GILBREATH
Suffix:
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 1:102 HOSPITAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845
Mailing Address - Country:US
Mailing Address - Phone:229-524-5217
Mailing Address - Fax:229-524-8114
Practice Address - Street 1:102 HOSPITAL CIRCLE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845
Practice Address - Country:US
Practice Address - Phone:229-524-5217
Practice Address - Fax:229-524-8114
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34522207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010060250OtherMEDICARE RR
GA00495118KMedicaid
93BBDWKMedicare ID - Type Unspecified
GA00495118KMedicaid