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General NPI Number Information
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NPI Number | 1356505051
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Entity Type | Organization
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Legal Business Name | FREDDY N. GATON
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 106 MCCRARY AVE
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City | ROBERTA
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State | GA
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Zip | 31078
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Country | US
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Telephone | 478-836-2819
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Fax | 478-836-2823
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Provider Business Mailing Address
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Address Line | PO BOX 1010
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City | ROBERTA
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State | GA
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Zip | 31078-1010
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Country | US
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Telephone | 478-836-2819
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Fax | 478-836-2823
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Authorized Official
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Title or Position | PHYSICIAN/PRACTICE ADMINISTRATOR
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Name | DR. FREDDY N GATON
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Credential | M.D.
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Telephone | 478-836-2819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 040386
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License Number State | GA
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