MEDICARE: DR. ANNE HAZEN GAGLIOTI M.D.

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	207Q00000X	Family Medicine Physician	MD036690	DC
2	207Q00000X	Family Medicine Physician	38695	IA
3	207Q00000X	Family Medicine Physician	074224	GA

General Provider Information

NPI Number	:	1699977751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE HAZEN GAGLIOTI M.D.

Provider Business Mailing Address
First Line	:	720 WESTVIEW DRIVE SW
Second Line	:	HARRIS BLDG., 100-A
City	:	ATLANTA
State	:	GA
Zip	:	30310
Country	:	US
Telephone Number	:	404-756-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 CLEVELAND AVE BLDG 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-6949
Country	:	US
Telephone Number	:	404-752-1000
Fax Number	:

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	10/11/2018

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