Individual
GWENDOLYN T DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
115 SUMNER RD, FAYETTEVILLE, GA 30214-4758
(678) 477-6904
Mailing address
PO BOX 56158, ATLANTA, GA 30343-0158
(404) 307-9575
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
28526
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00297349AL
—
GA
Enumeration date
05/11/2006
Last updated
07/08/2007
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