Healthcare Provider Details

I. General information

NPI: 1891718383
Provider Name (Legal Business Name): MICHAEL BRADLEY GOTTSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 JESSE JEWELL PKWY NE STE 302
GAINESVILLE GA
30501-3806
US

IV. Provider business mailing address

1475 JESSE JEWELL PKWY NE STE 302
GAINESVILLE GA
30501-3806
US

V. Phone/Fax

Practice location:
  • Phone: 770-292-6500
  • Fax: 770-292-6535
Mailing address:
  • Phone: 770-292-6500
  • Fax: 770-292-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number50102
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: