Healthcare Provider Details

I. General information

NPI: 1225217839
Provider Name (Legal Business Name): DAVID HOWARD GORNEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BELLEVUE RD STE 22
DUBLIN GA
31021-2889
US

IV. Provider business mailing address

2400 BELLEVUE RD STE 22 P O BOX 1716
DUBLIN GA
31040-1716
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-4032
  • Fax: 478-275-0533
Mailing address:
  • Phone: 478-275-4032
  • Fax: 478-275-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN148446
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: