Healthcare Provider Details

I. General information

NPI: 1013308311
Provider Name (Legal Business Name): MARGO RENEE GASKINS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 C SPAULDING RD SUITE B
MONTEZUMA GA
31063
US

IV. Provider business mailing address

202 BUSH CT
KATHLEEN GA
31047
US

V. Phone/Fax

Practice location:
  • Phone: 478-458-9992
  • Fax: 478-458-9996
Mailing address:
  • Phone: 478-508-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9414902
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN183351
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: