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General NPI Number Information
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NPI Number | 1144117839
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Entity Type | Organization
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Legal Business Name | GNM MD, LLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 112 BARTRAM OAKS WALK UNIT 600849
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City | SAINT JOHNS
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State | FL
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Zip | 32260-7734
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Country | US
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Telephone | 904-834-5175
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Fax |
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Provider Business Mailing Address
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Address Line | 112 BARTRAM OAKS WALK UNIT 600849
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City | SAINT JOHNS
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State | FL
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Zip | 32260-7734
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY PERSZYK
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Credential | MD
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Telephone | 904-834-5175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number |
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License Number State |
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