Healthcare Provider Details

I. General information

NPI: 1346686151
Provider Name (Legal Business Name): KATIE HOANG GUSCHING D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 PINE GROVE RD STE 115
CARTERSVILLE GA
30120-8483
US

IV. Provider business mailing address

175 PINE GROVE RD STE 115
CARTERSVILLE GA
30120-8483
US

V. Phone/Fax

Practice location:
  • Phone: 770-383-1883
  • Fax: 770-415-4095
Mailing address:
  • Phone: 770-383-1883
  • Fax: 770-415-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001509
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: