Provider Demographics
NPI:1790741114
Name:GORBATKIN, STEVEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:GORBATKIN
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 1:170 CAMDEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7418
Mailing Address - Country:US
Mailing Address - Phone:770-339-4225
Mailing Address - Fax:770-339-4797
Practice Address - Street 1:170 CAMDEN HILL RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7418
Practice Address - Country:US
Practice Address - Phone:770-339-4225
Practice Address - Fax:770-339-4797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist