Healthcare Provider Details

I. General information

NPI: 1003814716
Provider Name (Legal Business Name): JOHN P GORECKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NORTHSIDE FORSYTH DR SUITE 310
CUMMING GA
30041-6012
US

IV. Provider business mailing address

33 BUFORD VILLAGE WAY SUITE 325
BUFORD GA
30518-8843
US

V. Phone/Fax

Practice location:
  • Phone: 678-730-7796
  • Fax: 678-730-7786
Mailing address:
  • Phone: 678-730-7796
  • Fax: 678-730-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0429019
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number62853
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: