Individual
GINA BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
(912) 350-8715
Mailing address
1107 E 66TH ST, SAVANNAH, GA 31404-5701
(912) 350-8837
(912) 350-5118
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA9102907
FL
207Q00000X
Family Medicine Physician
Primary
OS22051
FL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00164456
RAILROAD MEDICARE - FLAGL
FL
Enumeration date
05/18/2006
Last updated
04/22/2026
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