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General NPI Number Information
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NPI Number | 1972508752
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Entity Type | Individual
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Provider Name | GUILLERMO GOMEZ NP
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 4146 JONESBORO RD
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City | FOREST PARK
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State | GA
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Zip | 30297-1038
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Country | US
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Telephone | 404-361-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 165 VICTORIA DR
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City | ELLENWOOD
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State | GA
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Zip | 30294-2854
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Country | US
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Telephone | 770-598-2158
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Fax | 404-361-2427
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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 | RN126015 NP
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License Number State | GA
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