MEDICARE: DR. JOHN P GORECKI MD

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	207T00000X	Neurological Surgery Physician	0429019	KS
2	207T00000X	Neurological Surgery Physician	62853	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003814716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN P GORECKI MD

Provider Business Mailing Address
First Line	:	33 BUFORD VILLAGE WAY
Second Line	:	SUITE 325
City	:	BUFORD
State	:	GA
Zip	:	30518-8843
Country	:	US
Telephone Number	:	678-730-7796
Fax Number	:	678-730-7786

Provider Business Practice Location Address
First Line	:	1100 NORTHSIDE FORSYTH DR
Second Line	:	SUITE 310
City	:	CUMMING
State	:	GA
Zip	:	30041-6012
Country	:	US
Telephone Number	:	678-730-7796
Fax Number	:	678-730-7786

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/25/2024

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Directions to “ DR. JOHN P GORECKI MD” Practice Location

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