Healthcare Provider Details

I. General information

NPI: 1649379025
Provider Name (Legal Business Name): JOHNNIE M. GATLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC PERRY POINT
PERRY POINT MD
21902
US

IV. Provider business mailing address

VAMC PERRY POINT BUILDING 364B
PERRY POINT MD
21902
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax: 410-642-1150
Mailing address:
  • Phone: 410-642-2411
  • Fax: 410-642-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number05735
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: