MEDICARE: GARY R BOTSTEIN 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	207RR0500X	Rheumatology Physician

General Provider Information

NPI Number	:	1023183415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY R BOTSTEIN MD

Provider Business Mailing Address
First Line	:	2712 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5910
Country	:	US
Telephone Number	:	404-299-0187
Fax Number	:	404-292-2766

Provider Business Practice Location Address
First Line	:	2712 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5910
Country	:	US
Telephone Number	:	404-299-0187
Fax Number	:	404-292-2766

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. GARY ROBERT BOTSTEIN
Credential	:	MD
Telephone Number	:	404-299-0187

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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