Healthcare Provider Details

I. General information

NPI: 1790741114
Provider Name (Legal Business Name): STEVEN M GORBATKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 CAMDEN HILL RD
LAWRENCEVILLE GA
30045-7418
US

IV. Provider business mailing address

170 CAMDEN HILL RD
LAWRENCEVILLE GA
30045-7418
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-4225
  • Fax: 770-339-4797
Mailing address:
  • Phone: 770-339-4225
  • Fax: 770-339-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number051326
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: