Provider Demographics
NPI:1750312195
Name:D'AMATO, GINA Z (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:Z
Last Name:D'AMATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:678-288-9555
Mailing Address - Fax:678-288-9556
Practice Address - Street 1:1100 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-256-4777
Practice Address - Fax:404-256-5515
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86790207R00000X
GA060446207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269968100Medicaid
FL46013OtherBLUE CROSS BLUE SHIELD
FL46013OtherBLUE CROSS BLUE SHIELD
FL269968100Medicaid
FLP00364049Medicare PIN