Healthcare Provider Details

I. General information

NPI: 1063228914
Provider Name (Legal Business Name): GABRIELA MONGE MS, NBC-HWC, CWP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SOMERSBY DR
DALLAS GA
30157-8086
US

IV. Provider business mailing address

260 SOMERSBY DR
DALLAS GA
30157-8086
US

V. Phone/Fax

Practice location:
  • Phone: 770-906-0026
  • Fax:
Mailing address:
  • Phone: 770-906-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3979718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: