Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 0429019 | KS |
Y | 207T00000X | Neurosurgeon | 62853 | GA |
NPI | 1003814716 |
---|---|
Provider Name | Dr. John P Gorecki |
First Address | Buford, GA 30518-8843 |
Second Address | Cumming, GA 30041-6012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100387000A | (05) | KS |
372501099B | (05) | GA |
E65880 | (02) | KS |