NPIMap

Organization Active NPI

My Gay Doctor, P.C.

  • Emergency Medicine Physician
  • Atlanta, GA
National Provider Identifier
1144467739
Registry record updated Jan 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
48962 Issued in GA
Legal business name
MY GAY DOCTOR, P.C.
Practice address
1648 Berkeley LN NE
Atlanta, GA 30329-2731
Phone
(404) 634-6557
NPI assigned
Jan 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Travis Roth, MD
Title
Owner/President
Phone
(404) 634-6557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X 48962 GA Primary

Addresses

Primary practice location

1648 Berkeley LN NE
Atlanta, GA 30329-2731

Mailing address

1648 Berkeley LN NE
Atlanta, GA 30329-2731
Phone (404) 634-6557

National Provider Directory

National Provider Directory

Locations

881 Ponce de Leon Ave NE
Ste 1
Atlanta, GA 30306
Phone (404) 835-7697

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232323200000",
    "number": "1144467739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 BERKELEY LN NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292731",
            "telephone_number": "404-634-6557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1648 BERKELEY LN NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292731",
            "telephone_number": "404-634-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY GAY DOCTOR, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-19",
        "last_updated": "2009-01-19",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "404-634-6557",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "48962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.