Healthcare Provider Details

I. General information

NPI: 1942239058
Provider Name (Legal Business Name): GARY RZEZNIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE STE 497
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8899
  • Fax:
Mailing address:
  • Phone: 404-251-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number046906
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number046906
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: