Healthcare Provider Details

I. General information

NPI: 1942691142
Provider Name (Legal Business Name): ANGELA MARIA GABELLA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 LONG ISLAND TER
ATLANTA GA
30342-2572
US

IV. Provider business mailing address

4930 LONG ISLAND TER
ATLANTA GA
30342-2572
US

V. Phone/Fax

Practice location:
  • Phone: 678-902-4827
  • Fax:
Mailing address:
  • Phone: 678-902-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIR009410
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: