Provider Demographics
NPI:1093790669
Name:GAY, BRIAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:GAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3480 PRESTON RIDGE RD STE 600
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5462
Mailing Address - Country:US
Mailing Address - Phone:770-300-0101
Mailing Address - Fax:770-300-0429
Practice Address - Street 1:425 BROAD ST SE
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3725
Practice Address - Country:US
Practice Address - Phone:770-718-9776
Practice Address - Fax:770-718-1910
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0454672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000791997EMedicaid
GAP00235315OtherRAILROAD MEDICARE
GAG76165Medicare UPIN
GA30BDLSBMedicare ID - Type Unspecified