Healthcare Provider Details

I. General information

NPI: 1003448911
Provider Name (Legal Business Name): KIRSTIN GABLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 02/08/2020
Certification Date: 02/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 WILSHIRE DR SW
MARIETTA GA
30064-4197
US

IV. Provider business mailing address

2119 WILSHIRE DR SW
MARIETTA GA
30064-4197
US

V. Phone/Fax

Practice location:
  • Phone: 504-330-0381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: