Basic Information
| Provider Information | |||||||||
| NPI: | 1245340835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | T DOUGLAS GURLEY MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 AUBURN AVE NE | ||||||||
| Address2: | SUITE 156 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303125412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048880228 | ||||||||
| FaxNumber: | 4048880552 | ||||||||
| Practice Location | |||||||||
| Address1: | 659 AUBURN AVE NE | ||||||||
| Address2: | SUITE 156 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303125412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048880228 | ||||||||
| FaxNumber: | 4048880552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | GURLEY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | DOUGLAS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4048880228 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 041817 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.