Provider Demographics
NPI:1376754200
Name:GILL, MATTHEW T (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4320 SUWANEE DAM RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1918
Mailing Address - Country:US
Mailing Address - Phone:404-297-4230
Mailing Address - Fax:678-710-9430
Practice Address - Street 1:4320 SUWANEE DAM RD
Practice Address - Street 2:STE 200
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1918
Practice Address - Country:US
Practice Address - Phone:404-297-4230
Practice Address - Fax:678-710-9430
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-02-01
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Provider Licenses
StateLicense IDTaxonomies
GA067303207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124177GMedicaid
GA003124177AMedicaid
GA2027G03929Medicare PIN
GA202I042197Medicare Oscar/Certification