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General NPI Number Information
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NPI Number | 1871398842
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Entity Type | Organization
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Legal Business Name | GATEWOOD CLINIC AND MEDSPA LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 715 VILLAGE SQUARE DR
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3379
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Country | US
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Telephone | 470-823-3051
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Fax | 678-615-2314
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Provider Business Mailing Address
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Address Line | 2989 WILSONE PL
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3379
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Country | US
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Telephone | 770-685-0718
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Fax | 678-615-2314
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY MICHELE PIERSON
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Credential |
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Telephone | 770-685-0718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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