MEDICARE: PHOEBE GATES THORPE M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	53889	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003814369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHOEBE GATES THORPE M.D., M.P.H.

Provider Business Mailing Address
First Line	:	5405 MEMORIAL DR STE D
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3236
Country	:	US
Telephone Number	:	404-296-3800
Fax Number	:	404-297-8753

Provider Business Practice Location Address
First Line	:	5405 MEMORIAL DR
Second Line	:	SUITE D
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3234
Country	:	US
Telephone Number	:	404-296-3800
Fax Number	:	404-297-8753

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/20/2009

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Directions to “ PHOEBE GATES THORPE M.D., M.P.H.” Practice Location

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