Healthcare Provider Details

I. General information

NPI: 1154214997
Provider Name (Legal Business Name): LOUIS GREGORY MARGULIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 VILLAGE CENTER PKWY
STOCKBRIDGE GA
30281-9044
US

IV. Provider business mailing address

155 N POND CT
ROSWELL GA
30076-2919
US

V. Phone/Fax

Practice location:
  • Phone: 770-474-5952
  • Fax: 770-474-1300
Mailing address:
  • Phone: 770-845-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: