Healthcare Provider Details

I. General information

NPI: 1790662153
Provider Name (Legal Business Name): ARIEL V GILMORE SA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 CHURCH ST NE
MARIETTA GA
30060-1110
US

IV. Provider business mailing address

840 ERNEST W BARRETT PKWY NW UNIT 440204
KENNESAW GA
30160-0101
US

V. Phone/Fax

Practice location:
  • Phone: 501-765-8527
  • 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: