Active NPI
Gerardo Julian Soracco, M.D.
- Military Health Care Provider
- Atlanta, GA
National Provider Identifier
1235575325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- License
- 11193
- Practice address
- 4415 Northside Chase NW
Atlanta, GA 30327-3567 - Phone
- (404) 364-9017
- NPI assigned
- May 15, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 11193 | GA | Primary |
Addresses
Primary practice location
4415 Northside Chase NW
Atlanta, GA 30327-3567
Mailing address
4415 Northside Chase NW
Atlanta, GA 30327-3567
Phone (404) 364-9017
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 |
|---|---|---|---|
| 011193 | GA | MD | General Practice Dentistry |
| 11193 | GA | MD | Military Health Care Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368576000000",
"number": "1235575325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4415 NORTHSIDE CHASE NW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303273567",
"telephone_number": "404-364-9017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4415 NORTHSIDE CHASE NW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303273567",
"telephone_number": "404-364-9017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SORACCO",
"first_name": "GERARDO",
"middle_name": "JULIAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-15",
"last_updated": "2013-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "GA",
"license": "11193",
"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 May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.