Healthcare Provider Details

I. General information

NPI: 1962875831
Provider Name (Legal Business Name): GABELLA BRAIN AND SPINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 W PEACHTREE ST NW UNIT 3401
ATLANTA GA
30309-3445
US

IV. Provider business mailing address

1280 W PEACHTREE ST NW UNIT 3401
ATLANTA GA
30309-3445
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: DR. ANGELA MARIA GABELLA
Title or Position: CEO
Credential: D.C.
Phone: 678-902-4827