Individual
MS. GWENDOLYN YVONNE NEALS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5892 BROOKSIDE DR SE, MABLETON, GA 30126-2880
(404) 313-6811
Mailing address
5892 BROOKSIDE DR SE, MABLETON, GA 30126-2880
(404) 313-6811
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
653853533A
—
GA
Enumeration date
10/01/2008
Last updated
10/01/2008
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