Provider Demographics
NPI:1679545537
Name:SOIFER, GREGG ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:ADAM
Last Name:SOIFER
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:PO BOX 678402
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8402
Mailing Address - Country:US
Mailing Address - Phone:334-712-9999
Mailing Address - Fax:
Practice Address - Street 1:1165 SANDERS RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5965
Practice Address - Country:US
Practice Address - Phone:800-324-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88962207Q00000X, 208100000X
AL31798208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11378617OtherCAQH
AL11378617OtherCAQH
AZI22333Medicare UPIN
AZ107353Medicare ID - Type Unspecified