Healthcare Provider Details

I. General information

NPI: 1245340835
Provider Name (Legal Business Name): T DOUGLAS GURLEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 AUBURN AVE NE SUITE 156
ATLANTA GA
30312-5412
US

IV. Provider business mailing address

659 AUBURN AVE NE SUITE 156
ATLANTA GA
30312-5412
US

V. Phone/Fax

Practice location:
  • Phone: 404-888-0228
  • Fax: 404-888-0552
Mailing address:
  • Phone: 404-888-0228
  • Fax: 404-888-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number041817
License Number StateGA

VIII. Authorized Official

Name: DR. THOMAS DOUGLAS GURLEY JR.
Title or Position: OWNER
Credential: MD
Phone: 404-888-0228