Provider Demographics
NPI:1497075774
Name:WARD, GREGORY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:WARD
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 1:960 JOHNSON FERRY RD STE 335
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1625
Mailing Address - Country:US
Mailing Address - Phone:404-497-8700
Mailing Address - Fax:404-497-8701
Practice Address - Street 1:960 JOHNSON FERRY RD STE 335
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1625
Practice Address - Country:US
Practice Address - Phone:404-497-8700
Practice Address - Fax:404-497-8701
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075424A207Y00000X
390200000X
GA88290207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201295690Medicaid
IN063220012Medicare PIN