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General NPI Number Information
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NPI Number | 1750735619
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Entity Type | Individual
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Provider Name | ANTHONY GATENS
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Gender | Male
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 2169 W POINT RD
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City | LAGRANGE
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State | GA
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Zip | 30240-4002
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Country | US
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Telephone | 706-668-5140
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Fax | 706-668-5142
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Provider Business Mailing Address
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Address Line | 2169 W POINT RD
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City | LAGRANGE
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State | GA
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Zip | 30240-4002
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Country | US
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Telephone | 706-668-5140
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Fax | 706-668-5142
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R092397
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License Number State | AR
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