Provider Demographics
NPI:1104463819
Name:KOECH, GARY SYDNEY III (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:SYDNEY
Last Name:KOECH
Suffix:III
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1339 N CROSSING DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3570
Mailing Address - Country:US
Mailing Address - Phone:304-813-9399
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-712-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN292038363LA2100X, 363LA2100X
GAAPRN-NP292038363LA2100X
GAPENDING363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care