Provider Demographics
NPI:1659640878
Name:GEORGE J. GATAKY, P.S.C.
Entity Type:Organization
Organization Name:GEORGE J. GATAKY, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GATAKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-636-3794
Mailing Address - Street 1:3 AUDUBON PLAZA DR STE 630
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1362
Mailing Address - Country:US
Mailing Address - Phone:502-636-3794
Mailing Address - Fax:502-634-9447
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 630
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1362
Practice Address - Country:US
Practice Address - Phone:502-636-3794
Practice Address - Fax:502-634-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14083207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty