Healthcare Provider Details

I. General information

NPI: 1285630574
Provider Name (Legal Business Name): JOHN PETER GAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342
US

IV. Provider business mailing address

5775 GLENRIDGE DRIVE NE B525
ATLANTA GA
30328-1849
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6323
  • Fax:
Mailing address:
  • Phone: 678-553-7783
  • Fax: 678-553-7793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number056709
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD15216
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: