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NPI Code Detail

MEDICARE: REBECCA GWIRA

MEDICARE: REBECCA GWIRA
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1598370074
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA GWIRA
Provider Business Mailing Address
First Line : 50 GLENLAKE PKWY STE 120
Second Line :
City : ATLANTA
State : GA
Zip : 30328-7270
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 50 GLENLAKE PKWY STE 120
Second Line :
City : ATLANTA
State : GA
Zip : 30328-7270
Country : US
Telephone Number : 678-328-4107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2020
Last Update Date : 09/11/2020

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Directions to “ REBECCA GWIRA ” Practice Location

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