Provider Demographics
NPI:1003814369
Name:THORPE, PHOEBE GATES (MD, MPH)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:GATES
Last Name:THORPE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 MEMORIAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3236
Mailing Address - Country:US
Mailing Address - Phone:404-296-3800
Mailing Address - Fax:404-297-8753
Practice Address - Street 1:5405 MEMORIAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3234
Practice Address - Country:US
Practice Address - Phone:404-296-3800
Practice Address - Fax:404-297-8753
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53889174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA175583131AMedicaid