Provider Demographics
NPI:1598776809
Name:ROBERTSON, GREGORY CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHRISTIAN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1550
Mailing Address - Country:US
Mailing Address - Phone:404-778-8240
Mailing Address - Fax:404-778-8241
Practice Address - Street 1:6335 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1549
Practice Address - Country:US
Practice Address - Phone:404-778-8240
Practice Address - Fax:404-778-8241
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052203207RC0000X
GA52203207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53446Medicare UPIN