Provider Demographics
NPI:1871673749
Name:MAULDIN, GREGORY LOY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LOY
Last Name:MAULDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 TREE LANE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-979-0367
Mailing Address - Fax:770-979-1830
Practice Address - Street 1:1800 TREE LANE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-979-0367
Practice Address - Fax:770-979-1830
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA036567207RP1001X
GA36567207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2664OtherGROUP MEDICARE #
GACD7170OtherRAILROAD MEDICARE
GA00540119AMedicaid
GAGRP2664OtherGROUP MEDICARE #
GA00540119AMedicaid