Healthcare Provider Details

I. General information

NPI: 1649922428
Provider Name (Legal Business Name): GAWDY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 N MAGNOLIA AVE STE 1300
OCALA FL
34475-5133
US

IV. Provider business mailing address

923 N MAGNOLIA AVE STE 1300
OCALA FL
34475-5133
US

V. Phone/Fax

Practice location:
  • Phone: 352-509-6359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAJE LAKE
Title or Position: PROVIDER
Credential:
Phone: 352-509-6359