Basic Information
| Provider Information | |||||||||
| NPI: | 1164531844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROPPER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 PEACHTREE RD NE | ||||||||
| Address2: | SUITE 575 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043500106 | ||||||||
| FaxNumber: | 4043500176 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 PEACHTREE RD NE | ||||||||
| Address2: | SUITE 575 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043500106 | ||||||||
| FaxNumber: | 4043500176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 28273 | GA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | P01092425 | 01 | GA | RAILROAD MEDICARE | OTHER | 293508 | 01 | BCBS | OTHER | 202I145321 | 01 | GA | MEDICARE | OTHER |