MEDICARE: T DOUGLAS GURLEY MD LLC

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	207RI0200X	Infectious Disease Physician	041817	GA

General Provider Information

NPI Number	:	1245340835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T DOUGLAS GURLEY MD LLC

Provider Business Mailing Address
First Line	:	659 AUBURN AVE NE
Second Line	:	SUITE 156
City	:	ATLANTA
State	:	GA
Zip	:	30312-5412
Country	:	US
Telephone Number	:	404-888-0228
Fax Number	:	404-888-0552

Provider Business Practice Location Address
First Line	:	659 AUBURN AVE NE
Second Line	:	SUITE 156
City	:	ATLANTA
State	:	GA
Zip	:	30312-5412
Country	:	US
Telephone Number	:	404-888-0228
Fax Number	:	404-888-0552

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS DOUGLAS GURLEY JR.
Credential	:	MD
Telephone Number	:	404-888-0228

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/02/2020

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