Individual
GERALD BORTOLAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 732-4000
Mailing address
5665 NEW NORTHSIDE DR, ATLANTA, GA 30384-0001
(770) 874-5400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
017997
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00202177G
—
GA
Enumeration date
09/21/2006
Last updated
01/31/2008
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