Healthcare Provider Details

I. General information

NPI: 1992938310
Provider Name (Legal Business Name): BRIAN MCGAULEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 E CONFEDERATE AVE SE
ATLANTA GA
30316-2534
US

IV. Provider business mailing address

845 E CONFEDERATE AVE SE
ATLANTA GA
30316-2534
US

V. Phone/Fax

Practice location:
  • Phone: 404-890-6985
  • Fax: 678-496-4575
Mailing address:
  • Phone: 404-890-6985
  • Fax: 678-496-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number037293
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: