Provider Demographics
NPI:1881604056
Name:MCCARTHY, GARY P (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:MCCARTHY
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:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-0657
Mailing Address - Country:US
Mailing Address - Phone:706-839-4095
Mailing Address - Fax:706-754-3518
Practice Address - Street 1:800 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4567
Practice Address - Country:US
Practice Address - Phone:706-839-4095
Practice Address - Fax:706-839-4097
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18679207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA921792038AMedicaid
MSE89176Medicare UPIN
GA511I200099Medicare PIN