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General NPI Number Information
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NPI Number | 1013954684
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Entity Type | Individual
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Provider Name | ZERAH KENYA GORHAM MD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 1700 MEDICAL WAY EASTSIDE MEDICAL CENTER
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City | SNELLVILLE
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State | GA
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Zip | 30278
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Country | US
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Telephone | 770-736-2376
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Fax | 770-736-2379
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Provider Business Mailing Address
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Address Line | 1700 MEDICAL WAY
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City | SNELLVILLE
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State | GA
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Zip | 30078-2195
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Country | US
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Telephone | 770-736-2440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 034839
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License Number State | GA
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