Individual
GARY GEORGE THEOFILIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO, MBA, DABAM
Contact information
Practice address
6125 BROADWATER TRL, CUMMING, GA 30040-9521
(412) 477-4493
Mailing address
6125 BROADWATER TRL, CUMMING, GA 30040-9521
(412) 477-4493
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
74400
GA
207LA0401X
Addiction Medicine (Anesthesiology) Physician
OS01718
PA
208VP0014X
Interventional Pain Medicine Physician
Primary
74400
GA
208VP0014X
Interventional Pain Medicine Physician
OS01718
PA
Other
Enumeration date
06/29/2010
Last updated
07/21/2022
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