Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT003069 | GA |
Y | 213ES0000X | Sports Medicine | AT003069 | GA |
NPI | 1568003275 |
---|---|
Provider Name | Derek Charles Gaffey |
First Address | Sandy Springs, GA 30350-3814 |
Second Address | Milton, GA 30004-7306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2019 |
Last Update Date | 03/10/2019 |