Healthcare Provider Details

I. General information

NPI: 1699694885
Provider Name (Legal Business Name): GEMA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 WESTBROOK RD BLDG D
SUWANEE GA
30024-4987
US

IV. Provider business mailing address

3533 OLD STATE RD
TALMO GA
30575-1350
US

V. Phone/Fax

Practice location:
  • Phone: 404-992-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC011181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: