=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396186862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRY E. SIEGEL, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2013
-----------------------------------------------------
Last Update Date | 09/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1874 PIEDMONT AVE NE STE 500E
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30324-4878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-607-0042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1221
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30077-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-281-9013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GARRY EARL SIEGEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 404-281-9013
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------