Provider Demographics
NPI:1245340835
Name:T DOUGLAS GURLEY MD LLC
Entity type:Organization
Organization Name:T DOUGLAS GURLEY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-888-0228
Mailing Address - Street 1:659 AUBURN AVE NE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-5412
Mailing Address - Country:US
Mailing Address - Phone:404-888-0228
Mailing Address - Fax:404-888-0552
Practice Address - Street 1:659 AUBURN AVE NE
Practice Address - Street 2:SUITE 156
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5412
Practice Address - Country:US
Practice Address - Phone:404-888-0228
Practice Address - Fax:404-888-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041817207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F30494Medicare UPIN
GRP6488Medicare PIN
GRP6488Medicare PIN