Provider Demographics
NPI:1790792166
Name:ESPER, GREGORY JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JACOB
Last Name:ESPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3671 LANTERN WALK LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1892
Mailing Address - Country:US
Mailing Address - Phone:404-294-9349
Mailing Address - Fax:494-294-9349
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:CLINIC A, 3RD FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-4395
Practice Address - Fax:404-778-2162
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0562842084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I2242Medicare UPIN