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NPI Code Detail

MEDICARE: DR. JAN MARIE GORNIAK DO

MEDICARE:  DR. JAN MARIE GORNIAK  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZF0201XForensic Pathology Physician76839GA

General Provider Information

NPI Number : 1346897824
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAN MARIE GORNIAK DO
Provider Business Mailing Address
First Line : 335 BROWNSTONES CIR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30312-1293
Country : US
Telephone Number : 614-570-4826
Fax Number :
Provider Business Practice Location Address
First Line : 430 PRYOR ST SW
Second Line :
City : ATLANTA
State : GA
Zip : 30312-2716
Country : US
Telephone Number : 404-613-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2019
Last Update Date : 08/20/2019

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Directions to “ DR. JAN MARIE GORNIAK DO” Practice Location

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