| Doctor Name: | GARY GEORGE THEOFILIS |
| NPI Number: | 1558672014 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO, MBA |
| License Number: | OS015718 |
| Business Practice Address: | 106 Allen St Cumming, GA - 300402602 |
| Business Phone Number: | 6784558693 |
| Business Fax Number: | |
| Mailing Address: | Po Box 80883, ATHENS |
| State: | GA |
| Postal Code: | 306080883 |
| Phone Number: | 6784558693 |
| Fax Number: | |
| NPI Enumeration Date: | 06/29/2010 |
| NPI Last Update Date: | 10/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS015718 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |