Healthcare Provider Details

I. General information

NPI: 1538721048
Provider Name (Legal Business Name): KURT CARLTON GOPAUL RPSGT,CCSH,RST, RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KURT CARLTON GOPAUL RPSGT, RST, RCP

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 09/03/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ETOWAH TRCE
FAYETTEVILLE GA
30214-5902
US

IV. Provider business mailing address

PO BOX 143327
FAYETTEVILLE GA
30214-6530
US

V. Phone/Fax

Practice location:
  • Phone: 678-860-5431
  • Fax:
Mailing address:
  • Phone: 678-860-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number010451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: