Active NPI
Preston Gantt, MD, SA-C
- Surgery Physician
- Loganville, GA
National Provider Identifier
1902304538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 34292
- Practice address
- 367 Athens Hwy Ste 100C
Loganville, GA 30052-2204 - Phone
- (770) 580-4929
- Fax
- (949) 561-5102
- NPI assigned
- Jan 29, 2018
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 34292 | FL | Primary |
Addresses
Primary practice location
367 Athens Hwy Ste 100C
Loganville, GA 30052-2204
Mailing address
367 Athens Hwy Ste 100C
Loganville, GA 30052-2204
Phone (770) 580-4929
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34292 | FL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696291200000",
"number": "1902304538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "367 ATHENS HWY STE 100C",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300522204",
"telephone_number": "770-580-4929",
"fax_number": "949-561-5102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "367 ATHENS HWY STE 100C",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300522204",
"telephone_number": "770-580-4929",
"fax_number": "949-561-5102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANTT",
"first_name": "PRESTON",
"name_prefix": "Dr.",
"credential": "MD, SA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-29",
"last_updated": "2023-10-03",
"certification_date": "2023-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "FL",
"license": "34292",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loganville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.