Provider Demographics
NPI:1659472363
Name:KOVAL, GREGG M (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:M
Last Name:KOVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5667 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-256-0775
Mailing Address - Fax:404-459-8426
Practice Address - Street 1:5667 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-256-0775
Practice Address - Fax:404-459-8426
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-12-02
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Provider Licenses
StateLicense IDTaxonomies
GA025202207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29974Medicare UPIN
D29974Medicare UPIN
GA11BDRWPMedicare PIN