Provider Demographics
NPI:1003918707
Name:MCGILLIVARY, GARY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:MCGILLIVARY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Mailing Address - Street 2:SUITE 2097
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2208
Mailing Address - Country:US
Mailing Address - Phone:404-778-3350
Mailing Address - Fax:404-778-3835
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:SUITE 2097
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-3350
Practice Address - Fax:404-778-3835
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA44018207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE24041Medicare UPIN