Dean, Gwendolyn T
Dean, Gwendolyn T is an sole proprietor health care provider with primary practice located at 115 Sumner Rd , Fayetteville GA 30214-4758. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Dean, Gwendolyn T can be contacted via phone (678) 477-6904.Contact Information
Primary practice address
115 Sumner Rd
Fayetteville GA 30214-4758
Phone: (678) 477-6904
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 28526 | Georgia |
Profile Details
| NPI number | 1629028386 |
|---|---|
| LBN Legal business name | Dean, Gwendolyn T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 11th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629028386 | NPPES |
| Georgia | MEDICAID | 00297349AL |
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