Healthcare Provider Details

I. General information

NPI: 1366602005
Provider Name (Legal Business Name): GATHLINE ETIENNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 440
ROSWELL GA
30076-4919
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 440
ROSWELL GA
30076-4919
US

V. Phone/Fax

Practice location:
  • Phone: 770-663-4649
  • Fax: 770-663-3930
Mailing address:
  • Phone: 770-663-4649
  • Fax: 770-663-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME107645
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number070551
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036173876
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: