Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 2797 | SC |
N | 213EG0000X | General Practice | 2797 | SC |
N | 1223P0300X | Periodontist | 345 | SC |
NPI | 1104989847 |
---|---|
Provider Name | Dr. Robert Geoffrey Gellin |
First Address | Charleston, SC 29425-0001 |
Second Address | Charleston, SC 29425-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2006 |
Last Update Date | 08/07/2007 |