Provider Demographics
NPI:1326224635
Name:GURLEY, T. DOUGLAS JR (MD)
Entity Type:Individual
Prefix:
First Name:T. DOUGLAS
Middle Name:
Last Name:GURLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:659 AUBURN AVE NE
Mailing Address - Street 2:STE 156
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-5412
Mailing Address - Country:US
Mailing Address - Phone:404-888-0228
Mailing Address - Fax:404-888-0552
Practice Address - Street 1:659 AUBURN AVE NE
Practice Address - Street 2:STE 156
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5412
Practice Address - Country:US
Practice Address - Phone:404-888-0228
Practice Address - Fax:404-888-0552
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA041817207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF30494Medicare UPIN
GA11SCCTZMedicare PIN