Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 34396 | SC |
N | 208000000X | Pediatrician | TRN10113 | FL |
N | 2080P0203X | Pediatric Critical Care Doctor | 62846 | GA |
N | 2080P0203X | Pediatric Critical Care Doctor | MMD.34396 MD | SC |
NPI | 1164508479 |
---|---|
Provider Name | Dr. William Bryan Gamble |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2006 |
Last Update Date | 16/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
343961 | (05) | SC |