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General NPI Number Information
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NPI Number | 1629904305
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Entity Type | Organization
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Legal Business Name | GUT REST DIAGNOSTICS LLC
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 110 SWEETGUM LN
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City | MINERAL BLUFF
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State | GA
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Zip | 30559-2588
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Country | US
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Telephone | 323-772-6313
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Fax |
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Provider Business Mailing Address
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Address Line | 110 SWEETGUM LN
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City | MINERAL BLUFF
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State | GA
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Zip | 30559-2588
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Country | US
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Telephone | 323-772-6313
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL DAVID ERDMAN
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Credential | MBBS
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Telephone | 310-866-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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