Basic Information
Provider Information
NPI: 1891098638
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CITY
FirstName: NATHAN
MiddleName: DREW
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1076
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305031076
CountryCode: US
TelephoneNumber: 7705327179
FaxNumber:  
Practice Location
Address1: 743 SPRING ST NE
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305013715
CountryCode: US
TelephoneNumber: 7705327179
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/17/2010
LastUpdateDate: 08/25/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X071948GAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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