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General NPI Number Information
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NPI Number | 1386671394
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Entity Type | Individual
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Provider Name | MICHAEL JOHN GAMBELLO MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 2165 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5307
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Country | US
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Telephone | 404-778-8570
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Fax | 404-778-8562
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Provider Business Mailing Address
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Address Line | 2165 N DECATUR RD EMORY CLINIC DEPARTMENT OF HUMAN GENETICS
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City | DECATUR
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State | GA
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Zip | 30033-5307
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Country | US
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Telephone | 404-778-8570
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Fax | 404-778-8562
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 67568
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | L3304
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License Number State | TX
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