Healthcare Provider Details

I. General information

NPI: 1801710637
Provider Name (Legal Business Name): MARQUITA GATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 GORDON COMMERCIAL DR
LAGRANGE GA
30240-5754
US

IV. Provider business mailing address

900 HOUSTON ST
LAGRANGE GA
30240-4816
US

V. Phone/Fax

Practice location:
  • Phone: 706-845-4054
  • Fax:
Mailing address:
  • Phone: 706-845-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: