Organization
MY GAY DOCTOR, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS ROTH MD (OWNER/PRESIDENT)
(404) 634-6557
Entity
Organization
Contact information
Practice address
1648 BERKELEY LN NE, ATLANTA, GA 30329-2731
(404) 634-6557
Mailing address
1648 BERKELEY LN NE, ATLANTA, GA 30329-2731
(404) 634-6557
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
48962
GA
Other
Enumeration date
01/19/2009
Last updated
01/19/2009
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