Individual
DR. GERALD DOMESCIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3193 HOWELL MILL RD NW, SUITE 110, ATLANTA, GA 30327-2119
(404) 355-7591
(404) 355-9175
Mailing address
3480 PRESTON RIDGE RD STE 600, CREDENTIALING DEPARTMENT, ALPHARETTA, GA 30005-5462
(770) 300-0101
(770) 300-0429
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
012247
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000941553E
—
GA
05
—
000941553I
—
GA
01
—
202G708830
RAILROAD MEDICARE
GA
01
—
300122041
RAILROAD MEDICARE
GA
01
—
300122052
RAILROAD MEDICARE
GA
01
—
P00098059
RAILROAD MEDICARE
GA
Enumeration date
12/05/2005
Last updated
10/02/2009
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