Provider Demographics
NPI:1710088505
Name:GAZAWAY, HOYT WAYBORN JR (MD)
Entity type:Individual
Prefix:DR
First Name:HOYT
Middle Name:WAYBORN
Last Name:GAZAWAY
Suffix:JR
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 1:2973 HEART PINE LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7643
Mailing Address - Country:US
Mailing Address - Phone:404-901-4075
Mailing Address - Fax:
Practice Address - Street 1:2973 HEART PINE LN
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7643
Practice Address - Country:US
Practice Address - Phone:404-901-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU035421208600000X
GA035421208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1706708OtherUNITED HEALTH CARE
GA2447OtherPROMINA
GA00506173AMedicaid
GA1622803OtherCIGNA
GA565908OtherUS HEALTHCARE
GA3459479OtherAETNA
GA205307637008OtherPRUDENTIAL
GA987125OtherBLUE CROSS BLUE SHIELD
GA2447OtherPROMINA
GAC72260Medicare UPIN