Individual
GARY A LEVENGOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 RIVERSIDE PKWY, LAWRENCEVILLE, GA 30043-5925
(770) 237-3475
(770) 237-3756
Mailing address
1900 RIVERSIDE PKWY, LAWRENCEVILLE, GA 30043-5925
(770) 237-3475
(770) 237-3756
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
040138
GA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
040138
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000665409F
—
GA
01
—
200045077
RAILROAD MEDICARE
GA
Enumeration date
07/28/2005
Last updated
07/02/2008
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