Provider Demographics
NPI:1891718383
Name:GOTTSMAN, MICHAEL BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:GOTTSMAN
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 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1611
Mailing Address - Country:US
Mailing Address - Phone:404-300-2476
Mailing Address - Fax:404-250-8010
Practice Address - Street 1:1475 JESSE JEWELL PKWY NE STE 302
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3806
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050102207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10062469OtherAMERIGROUP
GAP00339111OtherRR MEDICARE-GRP # CC4177
GA7444426OtherCIGNA
GA000908872DMedicaid
GA0900422OtherUHC
GA000908872CMedicaid
GA339832OtherWELLCARE
GA52864125OtherBCBS
GA339832OtherWELLCARE
GA000908872DMedicaid