Individual
DR. MICHAEL JOHN GAMBELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
2165 N DECATUR RD, DECATUR, GA 30033-5307
(404) 778-8570
(404) 778-8562
Mailing address
2165 N DECATUR RD, EMORY CLINIC DEPARTMENT OF HUMAN GENETICS, DECATUR, GA 30033-5307
(404) 778-8570
(404) 778-8562
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
67568
GA
207SG0201X
Clinical Genetics (M.D.) Physician
L3304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003122764A
—
GA
01
—
147519602
CSHCN
TN
05
—
147519602
—
TX
01
—
8135N6
BCBS
TX
Enumeration date
06/26/2006
Last updated
04/24/2014
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