Provider Demographics
NPI:1003896416
Name:GATON, FREDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:
Last Name:GATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MCCRARY AVE
Mailing Address - Street 2:
Mailing Address - City:ROBERTA
Mailing Address - State:GA
Mailing Address - Zip Code:31078-4916
Mailing Address - Country:US
Mailing Address - Phone:478-836-2819
Mailing Address - Fax:478-836-2823
Practice Address - Street 1:106 MCCRARY AVE
Practice Address - Street 2:
Practice Address - City:ROBERTA
Practice Address - State:GA
Practice Address - Zip Code:31078-4916
Practice Address - Country:US
Practice Address - Phone:478-836-2819
Practice Address - Fax:478-836-2823
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00665948BMedicaid
GAG11734Medicare UPIN