Healthcare Provider Details

I. General information

NPI: 1629904305
Provider Name (Legal Business Name): GUT REST DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SWEETGUM LN
MINERAL BLUFF GA
30559-2588
US

IV. Provider business mailing address

110 SWEETGUM LN
MINERAL BLUFF GA
30559-2588
US

V. Phone/Fax

Practice location:
  • Phone: 323-772-6313
  • Fax:
Mailing address:
  • Phone: 323-772-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DAVID ERDMAN
Title or Position: OWNER
Credential: MBBS
Phone: 310-866-7464