Provider Demographics
NPI:1710088505
Name:GAZAWAY, HOYT WAYBORN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HOYT
Middle Name:WAYBORN
Last Name:GAZAWAY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:770-963-2967
Mailing Address - Fax:770-339-4585
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 255
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:770-963-2967
Practice Address - Fax:770-339-4585
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA035421208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3459479OtherAETNA
GA565908OtherUS HEALTHCARE
GA1706708OtherUNITED HEALTH CARE
GA00506173AMedicaid
GA1622803OtherCIGNA
GA205307637008OtherPRUDENTIAL
GA2447OtherPROMINA
GA987125OtherBLUE CROSS BLUE SHIELD
GA2447OtherPROMINA
GAC72260Medicare UPIN