MEDICARE: DR. GREGORY PAUL PETRO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	051265	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124023304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY PAUL PETRO MD

Provider Business Mailing Address
First Line	:	3333 JODECO ROAD
Second Line	:	SUITE A
City	:	MCDONOUGH
State	:	GA
Zip	:	30253
Country	:	US
Telephone Number	:	770-692-4000
Fax Number	:	770-474-8510

Provider Business Practice Location Address
First Line	:	3333 JODECO ROAD
Second Line	:	SUITE A
City	:	MCDONOUGH
State	:	GA
Zip	:	30253
Country	:	US
Telephone Number	:	770-692-4000
Fax Number	:	770-474-8510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	02/22/2024

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