Healthcare Provider Details

I. General information

NPI: 1699476341
Provider Name (Legal Business Name): MRS. CARLOTTA ANN GABRIELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GWINNETT DR
LAWRENCEVILLE GA
30046-8444
US

IV. Provider business mailing address

175 GWINNETT DR
LAWRENCEVILLE GA
30046-8444
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-2411
  • Fax:
Mailing address:
  • Phone: 678-209-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number228735
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: