MEDICARE: DANA GORUM

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
1	183500000X	Pharmacist	021857	GA

General Provider Information

NPI Number	:	1386981330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA GORUM

Provider Business Mailing Address
First Line	:	6236 OLD HIGHWAY 5
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-2426
Country	:	US
Telephone Number	:	770-928-5536
Fax Number	:	770-928-5541

Provider Business Practice Location Address
First Line	:	6236 OLD HIGHWAY 5
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-2426
Country	:	US
Telephone Number	:	770-928-5536
Fax Number	:	770-928-5541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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Directions to “ DANA GORUM ” Practice Location

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