Provider Demographics
NPI:1265533830
Name:SOTOMAYOR, GERARDO L (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:L
Last Name:SOTOMAYOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GERRY
Other - Middle Name:L
Other - Last Name:SOTOMAYOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3957 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5254
Mailing Address - Country:US
Mailing Address - Phone:770-939-5102
Mailing Address - Fax:770-938-9323
Practice Address - Street 1:3957 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5254
Practice Address - Country:US
Practice Address - Phone:770-939-5102
Practice Address - Fax:770-938-9323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA170000129OtherMEDICARE R.R.
GA0511749OtherAETNA
GA4509386OtherAETNA MC
GA681004OtherBLUE CROSS
GA0700202OtherUHC
GA00526512AMedicaid
GA170000129OtherMEDICARE R.R.
GA0700202OtherUHC