Provider Demographics
NPI:1902891799
Name:GAUTHIER, J. CLAUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:CLAUDE
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:2400 MT. ZION PARKWAY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD MEDICAL OFFICE
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-603-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000833687BMedicaid
GA000833687BMedicaid
GAH03944Medicare UPIN