Healthcare Provider Details

I. General information

NPI: 1871430330
Provider Name (Legal Business Name): GABRIEL SOUSA LIMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 FREEDOM PKWY
CUMMING GA
30041-9178
US

IV. Provider business mailing address

6050 ROSWELL RD APT 436
ATLANTA GA
30328-4099
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-8283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124287
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: