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General NPI Number Information
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NPI Number | 1568003275
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Entity Type | Individual
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Provider Name | DEREK CHARLES GAFFEY MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 13025 BIRMINGHAM HWY
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City | MILTON
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State | GA
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Zip | 30004-7306
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Country | US
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Telephone | 470-254-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 SPRING CREEK LN
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-3814
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Country | US
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Telephone | 814-594-6785
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Fax |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | AT003069
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License Number State | GA
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