Provider Demographics
NPI:1447250048
Name:GOTAY, HECTOR (MD)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:
Last Name:GOTAY
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:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:592C MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2055
Practice Address - Country:US
Practice Address - Phone:770-534-1738
Practice Address - Fax:770-536-6556
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA163502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000119185JMedicaid
GA538092643AMedicare ID - Type Unspecified
GAD39994Medicare UPIN
GA000119185JMedicaid