Healthcare Provider Details

I. General information

NPI: 1891354510
Provider Name (Legal Business Name): GWENDOLYN GISINER GUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMORY GENETICS CLINIC 1365 CLIFTON ROAD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

WOODRUFF MEMORIAL RESEARCH BUILDING 101 WOODRUFF CIRCLE, 7TH FLOOR, SUITE 7130
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8570
  • Fax: 404-778-8562
Mailing address:
  • Phone: 404-778-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: