Individual
MRS. REENA T GUSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1100 JOHNSON FERRY RD STE 600, ATLANTA, GA 30342-1739
(404) 256-4777
(404) 256-5515
Mailing address
1835 SAVOY DR STE 300, ATLANTA, GA 30341-1071
(404) 256-4777
(404) 256-5515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006516
GA
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126804K
—
GA
01
—
202I978507
MEDICARE PTAN
GA
Enumeration date
06/06/2012
Last updated
08/31/2020
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