Individual
MIRIAM P GWATHNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1057 MAIN ST, FOREST PARK, GA 30297-1482
(404) 301-4555
(404) 301-4482
Mailing address
1057 MAIN ST, FOREST PARK, GA 30297-1482
(404) 301-4555
(404) 301-4482
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
063343
GA
207Q00000X
Family Medicine Physician
OS8157
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261406500
—
FL
Enumeration date
06/10/2005
Last updated
05/02/2023
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