Provider Demographics
NPI:1568003275
Name:GAFFEY, DEREK CHARLES (MS, ATC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:CHARLES
Last Name:GAFFEY
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 SPRING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3814
Mailing Address - Country:US
Mailing Address - Phone:814-594-6785
Mailing Address - Fax:
Practice Address - Street 1:13025 BIRMINGHAM HWY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-7306
Practice Address - Country:US
Practice Address - Phone:470-254-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0030692081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine