Provider Demographics
NPI:1417959065
Name:WERBEL, GORDON BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:BRADLEY
Last Name:WERBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TREE LANE RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-4700
Mailing Address - Country:US
Mailing Address - Phone:770-978-0561
Mailing Address - Fax:770-978-0546
Practice Address - Street 1:1800 TREE LANE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-4700
Practice Address - Country:US
Practice Address - Phone:770-978-0561
Practice Address - Fax:770-978-0546
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31154208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00404566AMedicaid
GA020024445OtherRAILROAD MEDICARE
GA000404566BMedicaid
GA020024445OtherRAILROAD MEDICARE