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General NPI Number Information
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NPI Number | 1821462979
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Entity Type | Organization
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Legal Business Name | GP WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 4855 FLOYD RD SW SUITE 104
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City | MABLETON
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State | GA
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Zip | 30126-1323
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Country | US
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Telephone | 770-485-3458
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Fax | 770-575-1050
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Provider Business Mailing Address
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Address Line | 4855 FLOYD RD SW SUITE 104
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City | MABLETON
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State | GA
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Zip | 30126-1323
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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 | PRESIDENT
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Name | RAVINDERPAL K GILL
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Credential | MD
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Telephone | 770-485-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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