Provider Demographics
NPI:1740239730
Name:MYGATT, GEORGE G (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:G
Last Name:MYGATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6002 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5600
Mailing Address - Country:US
Mailing Address - Phone:770-942-5227
Mailing Address - Fax:770-489-1589
Practice Address - Street 1:6002 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5600
Practice Address - Country:US
Practice Address - Phone:770-942-5227
Practice Address - Fax:770-489-7589
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA020462208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000281872AMedicaid
D30312Medicare UPIN