Provider Demographics
NPI:1396186862
Name:GARRY E. SIEGEL, M.D., P.C.
Entity Type:Organization
Organization Name:GARRY E. SIEGEL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-281-9013
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-1221
Mailing Address - Country:US
Mailing Address - Phone:404-281-9013
Mailing Address - Fax:
Practice Address - Street 1:1874 PIEDMONT AVE NE STE 500E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4878
Practice Address - Country:US
Practice Address - Phone:404-607-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000448383MMedicaid
GA16BDFZWMedicare UPIN