Basic Information
| Provider Information | |||||||||
| NPI: | 1104463819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOECH | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | SYDNEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 N HIGHLAND AVE NE APT 303 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303064673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048139399 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | EMORY MIDTOWN- DAVIS FISCHER BLD 3RD FLOOR, RM 3245A | ||||||||
| Address2: | 550 PEACHTREE STREET, N.E. | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046867858 | ||||||||
| FaxNumber: | 4046867841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2019 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN292038 | GA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 876479 | TX | N | Nursing Service Providers | Registered Nurse | 363LA2100X | PENDING | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | RN292038 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.