Healthcare Provider Details

I. General information

NPI: 1326312505
Provider Name (Legal Business Name): GS MEDICAL CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 S BRYANT AVE SUITE A
EDMOND OK
73013-6161
US

IV. Provider business mailing address

2805 S BRYANT AVE SUITE A
EDMOND OK
73013-6161
US

V. Phone/Fax

Practice location:
  • Phone: 405-340-0766
  • Fax: 405-844-3600
Mailing address:
  • Phone: 405-340-0766
  • Fax: 405-844-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15716
License Number StateOK

VIII. Authorized Official

Name: GAYATHRI DASHARATHY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-340-0766