MEDICARE: DREAM BREAST CARE CENTER 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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1477212223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM BREAST CARE CENTER LLC

Provider Business Mailing Address
First Line	:	2275 MARIETTA BLVD NW STE 270-317
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 MARIETTA BLVD NW STE 270-317
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2004
Country	:	US
Telephone Number	:	404-519-4578
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RYLAND J GORE
Credential	:	MD
Telephone Number	:	404-519-4578

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/09/2021

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Directions to “DREAM BREAST CARE CENTER LLC ” Practice Location

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