Healthcare Provider Details

I. General information

NPI: 1427365634
Provider Name (Legal Business Name): MICHELLE GORZELNIK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MAHONUY PA

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 MEDICAL PARK DR
AUSTELL GA
30106-1110
US

IV. Provider business mailing address

3820 MEDICAL PARK DR
AUSTELL GA
30106-1110
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-6041
  • Fax: 770-948-7994
Mailing address:
  • Phone: 770-948-6041
  • Fax: 770-948-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: