Healthcare Provider Details

I. General information

NPI: 1982306718
Provider Name (Legal Business Name): GABRIEL PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GATEWAY DRIVE
MACON GA
31210
US

IV. Provider business mailing address

101 GATEWAY DRIVE
MACON GA
31210
US

V. Phone/Fax

Practice location:
  • Phone: 478-210-1670
  • Fax:
Mailing address:
  • Phone: 478-210-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SABRY GABRIEL
Title or Position: OWNER
Credential: MD
Phone: 478-335-8311