Active NPI
Gerald Bortolazzo
- Emergency Medicine Physician
- Austell, GA
National Provider Identifier
1104925007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 017997
- Practice address
- 3950 Austell Rd
Austell, GA 30106-1121 - Phone
- (770) 732-4000
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 017997 | GA | Primary |
Addresses
Primary practice location
3950 Austell Rd
Austell, GA 30106-1121
Mailing address
5665 New Northside Dr
Atlanta, GA 30384-0001
Phone (770) 874-5400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00202177G | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017997 | GA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cobb Hospital, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Austell, GA
- NPI 1467420448
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201737600000",
"number": "1104925007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5665 NEW NORTHSIDE DR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303840001",
"telephone_number": "770-874-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 AUSTELL RD",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061121",
"telephone_number": "770-732-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORTOLAZZO",
"first_name": "GERALD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2008-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "GA",
"license": "017997",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00202177G",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.